Provider Demographics
NPI:1699764225
Name:MARTIN, ROBERT MONROE III (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MONROE
Last Name:MARTIN
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 WALL ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6360
Mailing Address - Country:US
Mailing Address - Phone:405-579-7560
Mailing Address - Fax:405-579-7563
Practice Address - Street 1:2417 WESTPORT DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6337
Practice Address - Country:US
Practice Address - Phone:405-579-7560
Practice Address - Fax:405-579-7563
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK926103T00000X
OK1539101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor