Individual
GREGORY JOSEPH MARTONICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
320 W WILLOW ST STE 6, WALLA WALLA, WA 99362-2922
(509) 525-4840
(509) 529-7355
Mailing address
PO BOX 1793, WALLA WALLA, WA 99362-0351
(509) 525-4840
(509) 529-7355
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
252-09-0018690
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0063736
L & I NUMBER
WA
05
—
1300342
—
WA
Enumeration date
10/24/2006
Last updated
07/08/2007
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