Provider Demographics
NPI:1083677017
Name:MARTIN, ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4812 S 109TH EAST AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5822
Mailing Address - Country:US
Mailing Address - Phone:918-236-4567
Mailing Address - Fax:918-236-4578
Practice Address - Street 1:4812 S 109TH EAST AVE
Practice Address - Street 2:STE. 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5822
Practice Address - Country:US
Practice Address - Phone:918-236-4567
Practice Address - Fax:918-236-4578
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2017-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK17339207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100128830AMedicaid
OK100128830AMedicaid
OKG03076Medicare UPIN