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General NPI Number Information
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NPI Number | 1801393913
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Entity Type | Individual
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Provider Name | NICHOLAS ALLEN MARTIN DO
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Gender | Male
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 301 NORTH FIRST ST (BLDG 46)
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City | ALTUS
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State | OK
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Zip | 73523-5047
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Country | US
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Telephone | 580-481-5419
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Fax |
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Provider Business Mailing Address
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Address Line | 301 NORTH FIRST ST (BLDG 46)
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City | ALTUS
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State | OK
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Zip | 73523-5047
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Country | US
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Telephone | 580-481-5419
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125.072843
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2020016504
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License Number State | MO
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