| Doctor Name: | PETER J MARTIN |
| NPI Number: | 1194857532 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 025211PA10000093 |
| Business Practice Address: | N. 115 Crosby Tekoa, WA - 990330629 |
| Business Phone Number: | 5092842423 |
| Business Fax Number: | 5092843434 |
| Mailing Address: | Po Box 629, TEKOA |
| State: | WA |
| Postal Code: | 990330629 |
| Phone Number: | 5092842423 |
| Fax Number: | 5092843434 |
| NPI Enumeration Date: | 03/12/2007 |
| NPI Last Update Date: | 11/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 025211PA10000093 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |