Provider Demographics
NPI:1336147727
Name:MARTIN, LOUIS F (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:F
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 1:1550 S PIONEER WAY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4613
Mailing Address - Country:US
Mailing Address - Phone:509-764-2928
Mailing Address - Fax:509-764-2929
Practice Address - Street 1:1550 S PIONEER WAY
Practice Address - Street 2:SUITE 370
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4613
Practice Address - Country:US
Practice Address - Phone:509-764-2928
Practice Address - Fax:509-764-2929
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015858208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8507543Medicaid
WA8870832Medicare PIN
WAC30240Medicare UPIN