Healthcare Provider Details

I. General information

NPI: 1346342664
Provider Name (Legal Business Name): DEAN E. MARTIN, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S COLUMBIA AVE SUITE 301
TULSA OK
74114-3505
US

IV. Provider business mailing address

2121 S. COLUMBIA AVE. SUITE 301
TULSA OK
74114-3517
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-2463
  • Fax: 918-749-2838
Mailing address:
  • Phone: 918-749-2463
  • Fax: 918-749-2838

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: DEAN ERWIN MARTIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 918-749-2463