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NPI Code Detail

MEDICARE: DR. AMANDA DEANN MARTIN DO

MEDICARE: DR. AMANDA DEANN MARTIN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207XX0005XSports Medicine (Orthopaedic Surgery) Physician2782TN
2207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianDO1125AL
3207XX0005XSports Medicine (Orthopaedic Surgery) Physician5695OK
4207X00000XOrthopaedic Surgery Physician5695OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134324825
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA DEANN MARTIN DO
Provider Business Mailing Address
First Line : 101 ROCKEFELLER DR
Second Line : SUITE 101
City : MUSKOGEE
State : OK
Zip : 74401-5056
Country : US
Telephone Number : 918-684-2663
Fax Number : 918-681-6804
Provider Business Practice Location Address
First Line : 2004 HAYES ST STE 200
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-2689
Country : US
Telephone Number : 615-324-1600
Fax Number : 615-324-1661
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2007
Last Update Date : 02/11/2021

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Directions to “ DR. AMANDA DEANN MARTIN DO” Practice Location

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