Provider Demographics
NPI:1275519381
Name:COOPER, MARTIN T (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:T
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:STE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3310
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-488-6010
Practice Address - Street 1:715 N FOREMAN ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1422
Practice Address - Country:US
Practice Address - Phone:918-256-8731
Practice Address - Fax:918-256-8234
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-03-20
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Provider Licenses
StateLicense IDTaxonomies
OK18889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243321102Medicare PIN
OKF87187Medicare UPIN