Individual
DAVID E MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
845 W CENTER ST, SUITE 200, POCATELLO, ID 83204-4205
(208) 232-6260
(208) 232-6259
Mailing address
PO BOX 2377, POCATELLO, ID 83206-2377
(208) 232-7862
(208) 232-7869
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA39
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010151329
BSI - POKY
ID
05
—
0021913
—
ID
01
—
PANR7
BCI - POKY
ID
Enumeration date
08/22/2005
Last updated
07/09/2007
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