Provider Demographics
NPI:1164489498
Name:MARTIN, BEN R III (MD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:R
Last Name:MARTIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 WEST MAIN STREET
Mailing Address - Street 2:STE 31
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4300
Mailing Address - Country:US
Mailing Address - Phone:334-793-6511
Mailing Address - Fax:334-677-5642
Practice Address - Street 1:4300 WEST MAIN STREET
Practice Address - Street 2:STE 31 WOMENS HEALTHCARE OF DOTHAN PC
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4300
Practice Address - Country:US
Practice Address - Phone:334-793-6511
Practice Address - Fax:334-677-5642
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008862207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010492Medicaid
AL000010492Medicaid
AL10492Medicare ID - Type Unspecified