Provider Demographics
NPI:1689765455
Name:MARTIN, DAVID C (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1725 E 19TH ST
Mailing Address - Street 2:STE 602
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5437
Mailing Address - Country:US
Mailing Address - Phone:918-748-7677
Mailing Address - Fax:918-748-7606
Practice Address - Street 1:1725 E 19TH ST
Practice Address - Street 2:STE 602
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5437
Practice Address - Country:US
Practice Address - Phone:918-748-7677
Practice Address - Fax:918-748-7606
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK14327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731412934OtherCOMMERCIAL
OK730536372059OtherBCBS
OK730536372059OtherBCBS