Provider Demographics
NPI:1881681369
Name:MARTIN, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
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:PO BOX 3489
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-3489
Mailing Address - Country:US
Mailing Address - Phone:206-386-9500
Mailing Address - Fax:206-386-9605
Practice Address - Street 1:3236 78TH AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3500
Practice Address - Country:US
Practice Address - Phone:206-275-5060
Practice Address - Fax:206-275-5061
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA152210OtherLABOR & INDUSTRY
WA5508MAOtherREGENCE
WA5891740001OtherDME
WA110222293OtherPALMETTO RR MEDICARE
WA1064112Medicaid
WAAB23165Medicare ID - Type Unspecified
WA110222293OtherPALMETTO RR MEDICARE