Basic Information
| Provider Information | |||||||||
| NPI: | 1629093521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10452 SILVERDALE WAY NW | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983839411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603077300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10452 SILVERDALE WAY NW | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983839411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603077300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD418492 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD60092328 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 04-35296 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00985818 | 01 | KS | RR MEDICARE | OTHER | P00343786 | 01 | PA | RAILROAD MEDICARE | OTHER | 8548638 | 05 | WA | MEDICAID | 1167MA | 01 | REGENCE | OTHER | 250587 | 01 | WA | LABOR & INDUSTRIES | OTHER | 068002138 | 01 | KS | MEDICARE PTAN | OTHER | 200748500A | 05 | KS | MEDICAID | 0019315930001 | 05 | PA | MEDICAID |