Provider Demographics
NPI:1659898633
Name:MARTIN, JOSHUA AARON (PA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:AARON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BRYANT WILLIAMS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1121
Mailing Address - Country:US
Mailing Address - Phone:541-274-5729
Mailing Address - Fax:541-274-5745
Practice Address - Street 1:2200 BRYANT WILLIAMS DR STE 1
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1121
Practice Address - Country:US
Practice Address - Phone:541-274-5729
Practice Address - Fax:541-274-5745
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA185011363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500732144Medicaid