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Individual

DR. GRANT L MARTIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
555 DAYTON ST STE C, EDMONDS, WA 98020-3476
(425) 774-4673
(425) 774-0690
Mailing address
555 DAYTON ST STE C, EDMONDS, WA 98020-3476
(425) 774-4673
(425) 774-0690

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
596
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MA1172
REGENCE BLUESHIELD RIDER#
WA
Enumeration date
11/06/2006
Last updated
07/08/2007
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