Provider Demographics
NPI:1194716159
Name:MARTIN, STEVEN L (PAC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PAC
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 930
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-0930
Mailing Address - Country:US
Mailing Address - Phone:307-329-3340
Mailing Address - Fax:
Practice Address - Street 1:116 WEST BRIDGE AVENUE
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331
Practice Address - Country:US
Practice Address - Phone:307-329-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002597363A00000X
WYPA856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant