Provider Demographics
NPI:1427007137
Name:MARTIN, STEPHEN KOHLER (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KOHLER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 N LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-5907
Mailing Address - Country:US
Mailing Address - Phone:918-273-9911
Mailing Address - Fax:918-273-9946
Practice Address - Street 1:1334 N LANSING AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-5907
Practice Address - Country:US
Practice Address - Phone:918-273-9911
Practice Address - Fax:918-273-9946
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1949208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-1832OtherMEDICARE
OK100134410AMedicaid
OK100768880IMedicaid
OK100768880JMedicaid
OK100768880JMedicaid
E09641Medicare UPIN