Healthcare Provider Details

I. General information

NPI: 1154338549
Provider Name (Legal Business Name): DEAN ERWIN MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S PEORIA AVE
TULSA OK
74120-3820
US

IV. Provider business mailing address

550 S PEORIA AVE
TULSA OK
74120-3820
US

V. Phone/Fax

Practice location:
  • Phone: 918-588-1900
  • Fax: 918-382-1242
Mailing address:
  • Phone: 918-588-1900
  • Fax: 918-382-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number13789
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: