Provider Demographics
NPI:1043247463
Name:MARTIN, STEPHEN ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROGER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4126
Mailing Address - Country:US
Mailing Address - Phone:405-743-4212
Mailing Address - Fax:405-743-1134
Practice Address - Street 1:707 S WESTERN RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4126
Practice Address - Country:US
Practice Address - Phone:405-743-4212
Practice Address - Fax:405-743-1134
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13792207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100800AMedicaid
OK100100800AMedicaid
$$$$$$$$$Medicare PIN
D34988Medicare UPIN