Provider Demographics
NPI:1871546671
Name:MARTIN, RICHARD PAUL (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 GRIFFIN AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2373
Mailing Address - Country:US
Mailing Address - Phone:360-825-7500
Mailing Address - Fax:360-825-3370
Practice Address - Street 1:2820 GRIFFIN AVE STE 210
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2373
Practice Address - Country:US
Practice Address - Phone:360-825-7500
Practice Address - Fax:360-825-3370
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046462207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021021Medicaid
LA1432202Medicaid
G05140Medicare UPIN