Provider Demographics
NPI:1992891535
Name:MARTIN, STEVEN D (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
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:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-0705
Mailing Address - Country:US
Mailing Address - Phone:573-873-7138
Mailing Address - Fax:
Practice Address - Street 1:145 W. US HWY 54
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020
Practice Address - Country:US
Practice Address - Phone:573-873-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO108096207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO032050220OtherMEDICARE PTAN (LRHS PRO FEES)
MO208099424Medicaid
MO208099424Medicaid
MOG00197Medicare UPIN
MO032050220Medicare ID - Type UnspecifiedCPIN