Provider Demographics
NPI:1346342664
Name:DEAN E. MARTIN, M.D., PC
Entity Type:Organization
Organization Name:DEAN E. MARTIN, M.D., PC
Other - Org Name:DEAN E. MARTIN, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-749-2463
Mailing Address - Street 1:2121 S. COLUMBIA AVE.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3517
Mailing Address - Country:US
Mailing Address - Phone:918-749-2463
Mailing Address - Fax:918-749-2838
Practice Address - Street 1:2121 S COLUMBIA AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3505
Practice Address - Country:US
Practice Address - Phone:918-749-2463
Practice Address - Fax:918-749-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK137892084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK446545683-003OtherBCBS
OK446545683-003OtherBCBS