Individual
VINCE RUSSELL MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
700 W CHEROKEE AVE, SALLISAW, OK 74955-4216
(918) 775-0007
(918) 775-8910
Mailing address
700 W CHEROKEE AVE, SALLISAW, OK 74955-4216
(918) 775-0007
(918) 775-8910
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1514
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1514
OKLAHOMA LICENSE
OK
01
—
34366
OK BUR OF NARCOTICS & DD
OK
Enumeration date
03/27/2007
Last updated
03/07/2023
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