Provider Demographics
NPI:1134324825
Name:MARTIN, AMANDA DEANN (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DEANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 ROCKEFELLER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5056
Mailing Address - Country:US
Mailing Address - Phone:918-684-2663
Mailing Address - Fax:918-681-6804
Practice Address - Street 1:2004 HAYES ST STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2689
Practice Address - Country:US
Practice Address - Phone:615-324-1600
Practice Address - Fax:615-324-1661
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2782207XX0005X
ALDO1125207XX0005X
OK5695207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200583770AMedicaid
AL1134324825Medicaid
OK200583770AMedicaid