Provider Demographics
NPI:1639372725
Name:MARTIN, JUSTIN PARISH (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PARISH
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 1:2431 W MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1251
Mailing Address - Country:US
Mailing Address - Phone:334-305-0305
Mailing Address - Fax:334-464-3796
Practice Address - Street 1:2431 W MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1251
Practice Address - Country:US
Practice Address - Phone:334-305-0305
Practice Address - Fax:334-446-3796
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL290852086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL29085OtherALABAMA LICENSE NUMBER