Provider Demographics
NPI:1972766806
Name:EBLE, JOSEPH MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARTIN
Last Name:EBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7718 E 91ST ST STE 220
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6064
Mailing Address - Country:US
Mailing Address - Phone:918-392-0720
Mailing Address - Fax:
Practice Address - Street 1:7718 E 91ST ST STE 220
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6064
Practice Address - Country:US
Practice Address - Phone:918-392-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI390200000X208D00000X
MN522002085R0202X
OK304382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
IAENROLLEDMedicaid
MN300005797Medicare PIN