Provider Demographics
NPI:1922232263
Name:LOYO MARTINEZ, MYRIAM DEL MAR (MD)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:DEL MAR
Last Name:LOYO MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:SJH-01
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-346-6826
Mailing Address - Fax:503-346-6826
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:SJH-01
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-346-6826
Practice Address - Fax:503-346-6826
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD164783207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
23455OtherMSO