Individual
MR. MICHAEL L MART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-7500
(208) 706-7501
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-7500
(208) 706-7501
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA77
ID
Other
Enumeration date
09/16/2006
Last updated
03/07/2017
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