Provider Demographics
NPI:1508116526
Name:STAMPLEY, MARTIN JR
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:STAMPLEY
Suffix:JR
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 1:1769 W FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-4924
Mailing Address - Country:US
Mailing Address - Phone:918-764-9675
Mailing Address - Fax:
Practice Address - Street 1:1769 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-4924
Practice Address - Country:US
Practice Address - Phone:918-764-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist