Provider Demographics
NPI:1144260787
Name:MARTIN, JAMES D (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
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 1:1415 E. KINCAID STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4126
Mailing Address - Country:US
Mailing Address - Phone:360-424-4111
Mailing Address - Fax:
Practice Address - Street 1:1015 25TH ST
Practice Address - Street 2:MEDICAL ARTS PAVILLION
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2703
Practice Address - Country:US
Practice Address - Phone:360-899-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039308207P00000X
WA00039308207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8272528Medicaid
OR041428015OtherBSOR
WA8472029Medicaid
WA1210MAOtherBSWA
OR278667Medicaid
ID000010150615OtherBSID
WA3079MAOtherBSWA
ID807175600Medicaid
WA4434MAOtherBSWA
WAG8800507Medicare PIN
WAG8850344Medicare PIN
WYW20701Medicare PIN
WYP00392840Medicare PIN
WAP00226301Medicare PIN
WAG8855921Medicare PIN
WAH08034Medicare UPIN
WA8472029Medicaid
OR278667Medicaid
IDP00392813Medicare PIN
WAG8906774Medicare PIN
WAG8857678Medicare PIN
ID1131341Medicare PIN