Healthcare Provider Details

I. General information

NPI: 1366546673
Provider Name (Legal Business Name): DANIEL CRAIG MARTIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14226 ELM
GLENPOOL OK
74033
US

IV. Provider business mailing address

PO BOX 1029
GLENPOOL OK
74033
US

V. Phone/Fax

Practice location:
  • Phone: 918-322-9510
  • Fax:
Mailing address:
  • Phone: 918-322-9510
  • Fax: 918-322-9753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2180
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: