Provider Demographics
NPI:1083678726
Name:BRONK, MARTIN IRWIN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:IRWIN
Last Name:BRONK
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:PO BOX 60000 FILE 72484
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160
Mailing Address - Country:US
Mailing Address - Phone:650-498-6500
Mailing Address - Fax:650-322-1329
Practice Address - Street 1:1300 CRANE STREET
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-498-6500
Practice Address - Fax:650-322-1329
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42455208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MMM00087MOtherNHIC
00G424550Medicare ID - Type Unspecified
MMM00087MOtherNHIC