Basic Information
Provider Information
NPI: 1154359065
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTINEZ
FirstName: STEVE
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5127
Address2:  
City: EVERETT
State: WA
PostalCode: 982065127
CountryCode: US
TelephoneNumber: 4252583900
FaxNumber:  
Practice Location
Address1: 1330 ROCKEFELLER AVE
Address2:  
City: EVERETT
State: WA
PostalCode: 982011684
CountryCode: US
TelephoneNumber: 4252590966
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/29/2006
LastUpdateDate: 09/04/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
246ZS0410XA83233CAN    
208600000XMD60394901WAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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