Basic Information
| Provider Information | |||||||||
| NPI: | 1881681369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3489 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981143489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063869500 | ||||||||
| FaxNumber: | 2063869605 | ||||||||
| Practice Location | |||||||||
| Address1: | 3236 78TH AVE SE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MERCER ISLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980403500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062755060 | ||||||||
| FaxNumber: | 2062755061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00027674 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 152210 | 01 | WA | LABOR & INDUSTRY | OTHER | 5508MA | 01 | WA | REGENCE | OTHER | 5891740001 | 01 | WA | DME | OTHER | 110222293 | 01 | WA | PALMETTO RR MEDICARE | OTHER | 1064112 | 05 | WA | MEDICAID |