Healthcare Provider Details

I. General information

NPI: 1144498130
Provider Name (Legal Business Name): DAVID E MARTIN MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N MONTE VISTA ST SUITE B
ADA OK
74820-4674
US

IV. Provider business mailing address

520 N MONTE VISTA ST SUITE B
ADA OK
74820-4674
US

V. Phone/Fax

Practice location:
  • Phone: 580-421-6470
  • Fax: 580-421-6472
Mailing address:
  • Phone: 580-421-6470
  • Fax: 580-421-6472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100165920B
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name: DR. DAVID EXLINE MARTIN
Title or Position: DOCTOR
Credential: M.D.
Phone: 580-421-6470