Provider Demographics
NPI:1285678987
Name:MARTIN, BENJAMIN O (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:O
Last Name:MARTIN
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:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-0328
Mailing Address - Country:US
Mailing Address - Phone:712-279-5830
Mailing Address - Fax:712-279-5883
Practice Address - Street 1:100 VALLEY VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:PENDER
Practice Address - State:NE
Practice Address - Zip Code:68047
Practice Address - Country:US
Practice Address - Phone:402-385-3033
Practice Address - Fax:402-385-3092
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0998740Medicaid
NE42128384911Medicaid
NE00416OtherBCBS NE
NE0998740Medicaid
NE273109Medicare PIN