Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 17339 | OK |
NPI | 1083677017 |
---|---|
Provider Name | Dr. Alan Martin |
First Address | Tulsa, OK 74146-5822 |
Second Address | Tulsa, OK 74146-5822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 09/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100128830A | (05) | OK |
G03076 | (02) | OK |