Provider Demographics
NPI:1073530705
Name:MARTHA M ROBINSON MD PC
Entity Type:Organization
Organization Name:MARTHA M ROBINSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-758-3750
Mailing Address - Street 1:114 N GRAND AVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-4013
Mailing Address - Country:US
Mailing Address - Phone:918-758-3750
Mailing Address - Fax:918-758-0342
Practice Address - Street 1:114 N GRAND AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4013
Practice Address - Country:US
Practice Address - Phone:918-758-3750
Practice Address - Fax:918-758-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19124207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK224721303-008OtherBCBS
OK200199850AMedicaid
OK200199850AMedicaid
OK224721303-008OtherBCBS