Provider Demographics
NPI:1588669402
Name:SMITH, MARTIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35201-0786
Mailing Address - Country:US
Mailing Address - Phone:866-313-5265
Mailing Address - Fax:205-313-5298
Practice Address - Street 1:205 MARENGO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6033
Practice Address - Country:US
Practice Address - Phone:866-313-5265
Practice Address - Fax:205-313-5298
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16668207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALBS3909833OtherDEA CERTIFICATE
F31927Medicare UPIN