Provider Demographics
NPI:1750352597
Name:GROTHEER, MARTIN HERMAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:HERMAN
Last Name:GROTHEER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10 S TREATY RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-5330
Mailing Address - Country:US
Mailing Address - Phone:918-542-6644
Mailing Address - Fax:918-542-6167
Practice Address - Street 1:10 S TREATY RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-5330
Practice Address - Country:US
Practice Address - Phone:918-542-6644
Practice Address - Fax:918-542-6167
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK10117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100258760AMedicaid
OKOKA104291Medicare PIN
OKC94996Medicare UPIN