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General NPI Number Information
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NPI Number | 1881251387
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Entity Type | Individual
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Provider Name | DEREK JUSTIN MARTINEZ DO
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Gender | Male
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 4502 E 41ST ST
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City | TULSA
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State | OK
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Zip | 74135-2536
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Country | US
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Telephone | 918-579-2367
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Fax |
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Provider Business Mailing Address
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Address Line | 21614 SE 238TH ST
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City | MAPLE VALLEY
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State | WA
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Zip | 98038-8564
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Country | US
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Telephone | 206-919-3301
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 7678
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License Number State | OK
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