Provider Demographics
NPI:1760587372
Name:MARTIN, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
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 1:2900 DOCTORS PARK DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8198
Mailing Address - Country:US
Mailing Address - Phone:541-772-6600
Mailing Address - Fax:541-842-9618
Practice Address - Street 1:2900 DOCTORS PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8198
Practice Address - Country:US
Practice Address - Phone:541-772-6600
Practice Address - Fax:541-842-9618
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18457208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR001930001OtherBLUE CROSS BLUE SHIELD ID
OR18457Medicaid
OROOWCQKLAMedicare ID - Type UnspecifiedPROVIDER MEDICARE ID #