Healthcare Provider Details

I. General information

NPI: 1033311154
Provider Name (Legal Business Name): GABRIEL MARTINEZ ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCBRIDE CLINIC, INC. 1110 N LEE
OKLAHOMA CITY OK
73103
US

IV. Provider business mailing address

MCBRIDE CLINIC, INC. 1110 N LEE
OKLAHOMA CITY OK
73103
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-9000
  • Fax: 405-230-9421
Mailing address:
  • Phone: 405-230-9000
  • Fax: 405-230-9421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number412
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: