Individual
EDWARD T MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9228 S MINGO RD, SUITE 200, TULSA, OK 74133-5718
(918) 592-0999
(918) 878-2499
Mailing address
9228 S MINGO RD, SUITE 200, TULSA, OK 74133-5718
(918) 592-0999
(918) 878-2499
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
20675
OK
207RC0000X
Cardiovascular Disease Physician
Primary
20675
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060049596
MEDICARE RAILROAD
OK
05
—
100028120A
—
OK
01
—
OK700124
MEDICARE PTAN
OK
01
—
P00613404
MEDICARE RAILROAD
OK
Enumeration date
01/24/2006
Last updated
09/15/2016
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