Provider Demographics
NPI:1487637088
Name:MARTIN, VINCENT E JR (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:E
Last Name:MARTIN
Suffix:JR
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 1:702 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1626
Mailing Address - Country:US
Mailing Address - Phone:334-493-2342
Mailing Address - Fax:334-493-2552
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1626
Practice Address - Country:US
Practice Address - Phone:334-493-2342
Practice Address - Fax:334-493-2552
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000152502085B0100X, 2085N0904X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051556337Medicaid
AL51002202OtherBLUE CROSS BLUE SHIELD
ALP00240172OtherRAILROAD MEDICARE
ALG49840Medicare UPIN
AL051556337MARMedicare ID - Type Unspecified