Provider Demographics
NPI:1639170038
Name:JONES, MARTIN K (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:K
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7840
Mailing Address - Country:US
Mailing Address - Phone:580-248-2229
Mailing Address - Fax:580-248-2208
Practice Address - Street 1:1002 SW 52ND ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7840
Practice Address - Country:US
Practice Address - Phone:580-248-2229
Practice Address - Fax:580-248-2208
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14827207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100113030AMedicaid
D34872Medicare UPIN
OK$$$$$$$$$MMedicare PIN