Provider Demographics
NPI:1720069230
Name:MARTIN, DONALD C JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:C
Last Name:MARTIN
Suffix:JR
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 1:5903 SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2811
Mailing Address - Country:US
Mailing Address - Phone:256-505-6826
Mailing Address - Fax:256-571-8918
Practice Address - Street 1:5903 SPRING CIR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2811
Practice Address - Country:US
Practice Address - Phone:256-505-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00015004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALA082362796OtherINDIVIDUAL MEDICARE NUMBER
AL241246Medicaid
AL529921560Medicaid
AL51000230OtherBCBS - GUNTERSVILLE OFFIC
ALE22574Medicare UPIN
AL5278760001Medicare NSC