Provider Demographics
NPI:1568430304
Name:HURTADO, MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:HURTADO
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 1:2911 TENNYSON AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-4693
Mailing Address - Country:US
Mailing Address - Phone:541-844-1495
Mailing Address - Fax:541-844-1492
Practice Address - Street 1:2911 TENNYSON AVE
Practice Address - Street 2:STE 201
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-4693
Practice Address - Country:US
Practice Address - Phone:541-844-1495
Practice Address - Fax:541-844-1495
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275318Medicaid
OR275318Medicaid
OR118546Medicare ID - Type Unspecified