Provider Demographics
NPI:1396848610
Name:MARTIN, KENT S (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 COX BLVD
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-4000
Mailing Address - Country:US
Mailing Address - Phone:256-389-1990
Mailing Address - Fax:256-389-1920
Practice Address - Street 1:426 COX BLVD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-4000
Practice Address - Country:US
Practice Address - Phone:256-389-1990
Practice Address - Fax:256-389-1920
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL169213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51078987OtherBLUE CROSS/BLUE SHIELD AL
AL000078987Medicare PIN
AL51078987OtherBLUE CROSS/BLUE SHIELD AL
AL5254050001Medicare NSC