Provider Demographics
NPI:1629093521
Name:MARTIN, JOEL E (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
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 1:10452 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9411
Mailing Address - Country:US
Mailing Address - Phone:360-307-7300
Mailing Address - Fax:
Practice Address - Street 1:10452 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9411
Practice Address - Country:US
Practice Address - Phone:360-307-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418492207R00000X
WAMD60092328207R00000X
KS04-35296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00985818OtherRR MEDICARE
PAP00343786OtherRAILROAD MEDICARE
WA8548638Medicaid
1167MAOtherREGENCE
WA250587OtherLABOR & INDUSTRIES
KS068002138OtherMEDICARE PTAN
KS200748500AMedicaid
PA0019315930001Medicaid
PA0019315930001Medicaid
G8884390Medicare PIN
1167MAOtherREGENCE
G8886412Medicare PIN
KS068002138OtherMEDICARE PTAN
G8885982Medicare PIN
PA061626KK2Medicare PIN
KSP00985818OtherRR MEDICARE