Individual
MR. JERRICO LAMON MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6726 E 26TH CT, TULSA, OK 74129-6206
(918) 406-7716
Mailing address
6726 E 26TH CT, TULSA, OK 74129-6206
(918) 406-7716
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/09/2012
Last updated
11/09/2012
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