Martin, Kenneth Lyle

Martin, Kenneth Lyle is an individual health care provider with primary practice located at 15298 Sw Royalty Pkwy , Tigard OR 97224-3904. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Martin, Kenneth Lyle can be contacted via phone (503) 620-0721.

Contact Information

Primary practice address
15298 Sw Royalty Pkwy Tigard OR 97224-3904
Phone: (503) 620-0721
Fax: (503) 968-1181
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 10582 Oregon

Profile Details

NPI number 1902875016
LBN Legal business name Martin, Kenneth Lyle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Feb 14th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902875016 NPPES
Oregon MEDICAID 167387

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