Provider Demographics
NPI:1780663708
Name:MARTIN, SCOTT D (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:STE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3310
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-488-6010
Practice Address - Street 1:1815 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4202
Practice Address - Country:US
Practice Address - Phone:405-743-7375
Practice Address - Fax:405-743-7253
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-02-28
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Provider Licenses
StateLicense IDTaxonomies
OK21251208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH34793Medicare UPIN