Individual
DR. TREVER J. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1024 E LOCUST ST, EMMETT, ID 83617
(208) 365-2338
(208) 365-0677
Mailing address
1202 E LOCUST ST, EMMETT, ID 83617-2715
(208) 365-2338
(208) 365-0677
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P-227
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316236797
NPI
ID
01
—
20005139
MEDICARE PTAN
ID
01
—
820382500
TAX ID
ID
Enumeration date
04/06/2011
Last updated
04/09/2019
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