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General NPI Number Information
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NPI Number | 1780680520
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Entity Type | Individual
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Provider Name | MARTIN T REILLY DO
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 401 E OKLAHOMA AVE SUITE A
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City | ENID
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State | OK
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Zip | 73701-5800
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Country | US
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Telephone | 580-242-5700
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Fax | 580-242-5712
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Provider Business Mailing Address
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Address Line | DEPT 960315
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City | OKLAHOMA CITY
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State | OK
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Zip | 73196-0315
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Country | US
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Telephone | 580-548-1367
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Fax | 580-548-1583
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4135
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 4135
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 4135
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License Number State | OK
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