Provider Demographics
NPI:1073580064
Name:MARTINSON, ALICE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MARIE
Last Name:MARTINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4320
Mailing Address - Country:US
Mailing Address - Phone:870-423-3774
Mailing Address - Fax:870-423-4670
Practice Address - Street 1:408 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4320
Practice Address - Country:US
Practice Address - Phone:870-423-3774
Practice Address - Fax:870-423-4670
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN7648207X00000X
CAG25165207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53233OtherBLUE CROSS BLUE SHIELD
AR5590017OtherAETNA
AR09-20000OtherUNITEDHEALTHCARE
AR149415OtherHEALTHLINK
AR14882000000OtherQUALCHOICE
AR149415OtherHEALTHLINK
AR5590017OtherAETNA