Basic Information
| Provider Information | |||||||||
| NPI: | 1376168013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEELE | ||||||||
| FirstName: | MARTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5040 ROSE ST | ||||||||
| Address2: | |||||||||
| City: | CHUBBUCK | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832022237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719018651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 465 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832014008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082344700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2020 | ||||||||
| LastUpdateDate: | 06/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MRM-1958 | ID | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.