MEDICARE: DR. CHRISTOPHER R. MARTIN MD

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
1	208100000X	Physical Medicine & Rehabilitation Physician	2009-01490	NC
2	208100000X	Physical Medicine & Rehabilitation Physician	A102864	CA
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	30288	OK

General Provider Information

NPI Number	:	1376727289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER R. MARTIN MD

Provider Business Mailing Address
First Line	:	4802 S 109TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-5822
Country	:	US
Telephone Number	:	918-392-1400
Fax Number	:	918-392-1401

Provider Business Practice Location Address
First Line	:	4812 S 109TH EAST AVE
Second Line	:	SUITE 300
City	:	TULSA
State	:	OK
Zip	:	74146-5826
Country	:	US
Telephone Number	:	918-236-4580
Fax Number	:	918-236-4587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	10/31/2013

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