Provider Demographics
NPI:1770508772
Name:ROBINSON, MARTHA MILNER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:MILNER
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N GRAND AVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-4013
Mailing Address - Country:US
Mailing Address - Phone:918-758-3750
Mailing Address - Fax:918-758-0342
Practice Address - Street 1:114 N GRAND AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4013
Practice Address - Country:US
Practice Address - Phone:918-758-3750
Practice Address - Fax:918-758-0342
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19124207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200199850AMedicaid
$$$$$$$$$-008OtherBCBS
OK245633901Medicare PIN
OKF10358Medicare UPIN
OK200199850AMedicaid