Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 22447 | OK |
NPI | 1003958893 |
---|---|
Provider Name | Michael D Martin |
First Address | Oklahoma City, OK 73104-5020 |
Second Address | Oklahoma City, OK 73104-3252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |