Provider Demographics
NPI:1982640215
Name:MARTINEZ, GREG T (PA)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:T
Last Name:MARTINEZ
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 1:930 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1409
Mailing Address - Country:US
Mailing Address - Phone:425-595-3900
Mailing Address - Fax:425-595-3905
Practice Address - Street 1:930 N BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1409
Practice Address - Country:US
Practice Address - Phone:425-595-3900
Practice Address - Fax:425-595-3905
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60700541363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP96471Medicare UPIN
NJP96471Medicare UPIN
NM343325903Medicare ID - Type Unspecified