Individual
MR. BRIAN T. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
520 S EAGLE RD STE 1234, MERIDIAN, ID 83642-6355
(208) 429-0300
(208) 429-0305
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1767
ID
363A00000X
Physician Assistant
PA21543
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0969PA
—
SC
01
—
P00886826
RAILROAD MC ID-RSFPN
SC
05
—
PA-1767
—
ID
Enumeration date
02/28/2010
Last updated
02/20/2024
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