Provider Demographics
NPI:1801804448
Name:MARTINEZ, TOMAS GREGORY (DC)
Entity type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:GREGORY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 E 91ST ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6047
Mailing Address - Country:US
Mailing Address - Phone:918-493-2777
Mailing Address - Fax:918-493-2778
Practice Address - Street 1:7614 E 91ST ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6047
Practice Address - Country:US
Practice Address - Phone:918-493-2777
Practice Address - Fax:918-493-2778
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKV01676Medicare UPIN
OK245428702Medicare ID - Type Unspecified