Provider Demographics
NPI:1184669749
Name:WATTERSON, MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:WATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E SUNSET DR
Mailing Address - Street 2:#145, PMB 479
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-3597
Mailing Address - Country:US
Mailing Address - Phone:360-220-1035
Mailing Address - Fax:
Practice Address - Street 1:1225 E SUNSET DR
Practice Address - Street 2:#145, PMB 479
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3597
Practice Address - Country:US
Practice Address - Phone:360-220-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038377207P00000X, 207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8254138Medicaid
WA0225721OtherL & I (REGULAR)
WA192924512OtherUS DEPT OF LABOR (FEDERAL
WA8945746OtherL & I (CRIME VICTIM)
WA911753976OtherGROUP HEALTH COOPERATIVE
H18592Medicare UPIN
WA8254138Medicaid