Provider Demographics
NPI:1184784019
Name:MARTIN, PATRICK L (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
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 1:10 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:31833-5225
Mailing Address - Country:US
Mailing Address - Phone:334-756-2207
Mailing Address - Fax:334-756-2213
Practice Address - Street 1:10 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3665
Practice Address - Country:US
Practice Address - Phone:334-756-2203
Practice Address - Fax:334-756-2213
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22670207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51020415OtherBLUE CROSS ALABAMA
ALG92088Medicare UPIN
000020415Medicare ID - Type Unspecified