Provider Demographics
NPI:1659374049
Name:MARTENS, JEFFREY D (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:MARTENS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 NW 56TH ST
Mailing Address - Street 2:STE 206
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4426
Mailing Address - Country:US
Mailing Address - Phone:405-602-8390
Mailing Address - Fax:405-602-8391
Practice Address - Street 1:3100 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7900
Practice Address - Country:US
Practice Address - Phone:405-602-8390
Practice Address - Fax:405-602-8391
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100132310A,B,CMedicaid
OKS70367Medicare UPIN
OK100132310A,B,CMedicaid