Provider Demographics
NPI:1659454254
Name:VERMILLION, JOHN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:VERMILLION
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 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2055 EAST SOUTH BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-0000
Practice Address - Country:US
Practice Address - Phone:334-747-2999
Practice Address - Fax:334-747-7276
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK79352086S0127X
AL000267652086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051007174OtherBLUE CROSS BLUE SHIELD
AL1881881266OtherMSS NPI
AL009913011Medicaid
AL051556225Medicaid
AL20-3204949OtherMONTGOMERY SURGICAL SPEC
AL510I020007OtherMEDICARE PROVIDER
ALP00656756OtherMEDICARE RAILROAD
AL51001703OtherBC/BS PROVIDER #
AL1881881266OtherMSS NPI
AL009913011Medicaid