Provider Demographics
NPI:1861559627
Name:KLOS, MARTIN M (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:M
Last Name:KLOS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3831 MAIN STREET
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-5801
Mailing Address - Country:US
Mailing Address - Phone:541-746-4468
Mailing Address - Fax:541-746-4562
Practice Address - Street 1:3831 MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5801
Practice Address - Country:US
Practice Address - Phone:541-746-4468
Practice Address - Fax:541-746-4562
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD18059207LP2900X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA53550Medicare UPIN