Provider Demographics
NPI:1649431982
Name:ZANE, MARTIN (M D)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:ZANE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24975 ELDORADO MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:HIDDEN HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1215
Mailing Address - Country:US
Mailing Address - Phone:818-346-4507
Mailing Address - Fax:818-346-4565
Practice Address - Street 1:24975 ELDORADO MEADOW RD
Practice Address - Street 2:
Practice Address - City:HIDDEN HILLS
Practice Address - State:CA
Practice Address - Zip Code:91302-1215
Practice Address - Country:US
Practice Address - Phone:818-346-4507
Practice Address - Fax:818-346-4565
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16246207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG16246Medicare PIN