Individual
MARTIN MAYTUBBY SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9 10TH AVE NW, ARDMORE, OK 73401-5929
(580) 226-1656
Mailing address
9 10TH AVE NW, ARDMORE, OK 73401-5929
(580) 226-1656
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
821
OK
Other
Enumeration date
10/05/2010
Last updated
10/14/2011
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