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NPI Code Detail

MEDICARE: LISA A MARTIN

MEDICARE: LISA A MARTIN
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1508529983
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA A MARTIN
Provider Business Mailing Address
First Line : 31312 E 683 RD
Second Line :
City : WAGONER
State : OK
Zip : 74467-6304
Country : US
Telephone Number : 918-813-1005
Fax Number :
Provider Business Practice Location Address
First Line : 1219 W DUPONT ST
Second Line :
City : CLAREMORE
State : OK
Zip : 74017-5318
Country : US
Telephone Number : 918-341-1424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2021
Last Update Date : 10/21/2021

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Directions to “ LISA A MARTIN ” Practice Location

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