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NPI Code Detail

MEDICARE: JEFFREY D MARTENS PA

MEDICARE: JEFFREY D MARTENS PA
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
1363A00000XPhysician Assistant704OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659374049
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY D MARTENS PA
Provider Business Mailing Address
First Line : 3330 NW 56TH ST
Second Line : STE 206
City : OKLAHOMA CITY
State : OK
Zip : 73112-4426
Country : US
Telephone Number : 405-602-8390
Fax Number : 405-602-8391
Provider Business Practice Location Address
First Line : 3100 SW 89TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-7900
Country : US
Telephone Number : 405-602-8390
Fax Number : 405-602-8391
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 03/01/2014

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Directions to “ JEFFREY D MARTENS PA” Practice Location

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