Provider Demographics
NPI:1982613030
Name:MARTINEZ, MARS SURBANO (MD)
Entity Type:Individual
Prefix:
First Name:MARS
Middle Name:SURBANO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 W HEFNER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4535
Mailing Address - Country:US
Mailing Address - Phone:405-722-5500
Mailing Address - Fax:405-720-4404
Practice Address - Street 1:7109 W HEFNER RD
Practice Address - Street 2:SUITE D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4534
Practice Address - Country:US
Practice Address - Phone:405-722-5500
Practice Address - Fax:405-720-4404
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100253420BMedicaid
OK400522462OtherMEDICARE GROUP NUMBER
D42623Medicare UPIN
OK100253420BMedicaid