Provider Demographics
NPI:1477845881
Name:SCHREEDER, MARTIN F (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:F
Last Name:SCHREEDER
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 1:111 S MARION ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2552
Mailing Address - Country:US
Mailing Address - Phone:256-230-5280
Mailing Address - Fax:256-427-4117
Practice Address - Street 1:700 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2422
Practice Address - Country:US
Practice Address - Phone:256-233-9151
Practice Address - Fax:256-216-9676
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.206548207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2155407Medicaid
LA332302YH54OtherMEDICARE - PTAN