Provider Demographics
NPI:1356358808
Name:MARTIN, KEITH CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:CHRISTOPHER
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 1:69 AVA LN
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-3457
Mailing Address - Country:US
Mailing Address - Phone:334-398-1636
Mailing Address - Fax:
Practice Address - Street 1:7065 SYDNEY CURV
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3509
Practice Address - Country:US
Practice Address - Phone:334-647-1007
Practice Address - Fax:334-647-1117
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19884207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL33834OtherBLUE CROSS/BLUE SHIELD
AL7410403OtherUNITED HEALTHCARE
AL33834Medicaid
AL640801795OtherTRICARE
ALG27457Medicare UPIN