Provider Demographics
NPI:1760484547
Name:MARTENS, ROYCE GREGORY (DO)
Entity Type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:GREGORY
Last Name:MARTENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 E TALIAFERRO ST
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-3410
Mailing Address - Country:US
Mailing Address - Phone:580-677-9500
Mailing Address - Fax:580-677-9505
Practice Address - Street 1:207 E TALIAFERRO ST
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-3410
Practice Address - Country:US
Practice Address - Phone:580-677-9500
Practice Address - Fax:580-677-9505
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100123700CMedicaid
OK080016807OtherRAILROAD MEDICARE
OKE09852Medicare UPIN
OK100123700CMedicaid
OK247612213Medicare ID - Type UnspecifiedDFMC MEDICARE