Provider Demographics
NPI:1336102391
Name:MARTIN, TERRY KEITH (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:KEITH
Last Name:MARTIN
Suffix:
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 1:2090 COLUMBIANA RD
Mailing Address - Street 2:SUITE 4400
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2153
Mailing Address - Country:US
Mailing Address - Phone:205-824-8000
Mailing Address - Fax:205-824-8111
Practice Address - Street 1:810 SAINT VINCENTS DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1601
Practice Address - Country:US
Practice Address - Phone:205-939-7855
Practice Address - Fax:205-824-8111
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL99612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521235OtherBLUE CROSS BLUE SHIELD
AL51013096OtherBLUE CROSS/BLUE SHIELD
AL51516211OtherBLUE CROSS/BLUE SHIELD
ALP00212995Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ALC76206Medicare UPIN
AL51521235OtherBLUE CROSS BLUE SHIELD
AL51013096OtherBLUE CROSS/BLUE SHIELD