Provider Demographics
NPI:1114425246
Name:MARTIN, XAVIER D
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N FAIRLAND ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4203
Mailing Address - Country:US
Mailing Address - Phone:918-825-1405
Mailing Address - Fax:918-876-3436
Practice Address - Street 1:151 WALNUT CREEK MH PARK
Practice Address - Street 2:
Practice Address - City:CHOUTEAU
Practice Address - State:OK
Practice Address - Zip Code:74337-6291
Practice Address - Country:US
Practice Address - Phone:918-944-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist