Individual
DUSTIN DARYL MARTINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1103 E BOXELDER RD, STE U, GILLETTE, WY 82718-5582
(307) 686-8177
Mailing address
1103 E BOXELDER RD, STE U, GILLETTE, WY 82718-5582
(208) 288-1155
(208) 288-0424
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT1215
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W21893
MEDICARE-NORIDIAN
WY
Enumeration date
10/12/2007
Last updated
09/02/2015
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