Individual
VINCE RUSSELL MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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