Provider Demographics
NPI:1366546673
Name:MARTIN, DANIEL CRAIG (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CRAIG
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033
Mailing Address - Country:US
Mailing Address - Phone:918-322-9510
Mailing Address - Fax:918-322-9753
Practice Address - Street 1:14226 ELM
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033
Practice Address - Country:US
Practice Address - Phone:918-322-9510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
731162079001OtherBCBS
OK1000004050AMedicaid
E09721Medicare UPIN