Healthcare Provider Details

I. General information

NPI: 1811875032
Provider Name (Legal Business Name): MARTIN CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N BAILEY ST
PRYOR OK
74361-4202
US

IV. Provider business mailing address

122 N BAILEY ST
PRYOR OK
74361-4202
US

V. Phone/Fax

Practice location:
  • Phone: 918-825-0216
  • Fax: 918-824-1919
Mailing address:
  • Phone: 918-825-0216
  • Fax: 918-824-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICHARD MARTIN
Title or Position: OWNER/SOLE MEMBER
Credential: MD
Phone: 918-825-0216