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NPI Code Detail

MEDICARE: MOLLY MARTIN MD

MEDICARE: MOLLY MARTIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician38340OK

General Provider Information

NPI Number : 1306469556
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY MARTIN MD
Provider Business Mailing Address
First Line : 1261 E TULSA AVE
Second Line :
City : KANSAS
State : OK
Zip : 74347-7026
Country : US
Telephone Number : 918-868-2175
Fax Number : 479-373-6069
Provider Business Practice Location Address
First Line : 1261 E TULSA AVE
Second Line :
City : KANSAS
State : OK
Zip : 74347-7026
Country : US
Telephone Number : 918-868-2175
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2020
Last Update Date : 08/22/2024

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Directions to “ MOLLY MARTIN MD” Practice Location

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