Roger James Martindale, DO
Individual provider Active NPI General Practice Physician · Custer, WA
NPI 1235401324 · NPPES record last updated Feb 3, 2012
Key facts
- NPI
- 1235401324
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 00000740 (WA)
- Practice address
- 2818 Stein Hill LN
Custer, WA 98240-9243 - Phone
- (360) 366-2682
- NPI assigned
- Feb 3, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00000740 | WA | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 00000740 | WA | Yes |
Addresses
Primary practice location
2818 Stein Hill LN
Custer, WA 98240-9243
Mailing address
2818 Stein Hill LN
Custer, WA 98240-9243
Phone (360) 366-2682
Other providers in Custer, WA
All providers in Custer, WA · General Practice Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.