Provider Demographics
NPI:1689636532
Name:MARTIN, DOUGLAS WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WAYNE
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 1:4230 WAR EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51109-1700
Mailing Address - Country:US
Mailing Address - Phone:712-224-4300
Mailing Address - Fax:712-224-4302
Practice Address - Street 1:4230 WAR EAGLE DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51109-1700
Practice Address - Country:US
Practice Address - Phone:712-224-4300
Practice Address - Fax:712-224-4302
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA288862083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDF39390Medicare UPIN