Provider Demographics
NPI:1780063933
Name:MARTIN, PARKER BON (PA)
Entity type:Individual
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First Name:PARKER
Middle Name:BON
Last Name:MARTIN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:3433 NW 56TH ST
Mailing Address - Street 2:STE 670
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4455
Mailing Address - Country:US
Mailing Address - Phone:405-951-4345
Mailing Address - Fax:405-951-4392
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:STE 670
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-951-4345
Practice Address - Fax:405-951-4392
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2016-02-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant