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Individual

EZEKIEL MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
BA, PSS

Contact information

Practice address
2901 E BURNSIDE ST, PORTLAND, OR 97214-1831
(503) 238-5203
Mailing address
2901 E BURNSIDE, PORTLAND, OR 97214

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
OR

Other

Enumeration date
10/28/2015
Last updated
10/28/2015
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