Provider Demographics
NPI:1154338549
Name:MARTIN, DEAN ERWIN (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:ERWIN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3820
Mailing Address - Country:US
Mailing Address - Phone:918-588-1900
Mailing Address - Fax:918-382-1242
Practice Address - Street 1:550 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:918-382-1242
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK137892084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100123800-AMedicaid
OK73-1042545OtherTRICARE GROUP #
OK73-1042545OtherGROUP MEDICARE
OK100732910OtherMEDICAID/SOONERCARE GROUP #
OK73-1042545OtherCOMMUNITY CARE OF OKLAHOMA
OK73-1042545OtherBLUE CROSS BLUE SHEILD
OK73-1042545OtherBLUE CROSS BLUE SHEILD