Individual
TEACKLE W. MARTIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 HOSPITAL DRIVE, SUITE 200, SEDRO WOOLLEY, WA 98284
(360) 856-4222
(360) 854-2792
Mailing address
1400 E. KINCAID STREET, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00014430
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1543602
—
WA
01
—
263561
LABOR & INDUSTRIES
WA
Enumeration date
04/26/2006
Last updated
11/03/2010
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