Provider Demographics
NPI:1780634048
Name:MARTIN, RICHARD STEVENS (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEVENS
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 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:ACC STE 306
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000268272085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL105627Medicaid
AL515-30567OtherBCBS AL
AL051531133OtherBCBS AL (UAB)
AL515-30615OtherBCBS AL
AL009934348Medicaid
AL009934349Medicaid
AL515-31169OtherBCBS AL
AL630842160OtherAETNA
AL009954352Medicaid
MS08483033Medicaid
AL511-61145OtherBLUE CROSS
AL515-30837OtherBCBS AL
AL515-30837OtherBLUE CROSS
AL515-30575OtherBCBS AL
AL515-90127OtherBLUE CROSS
AL009934347Medicaid
AL009934182Medicaid
AL009934351Medicaid
AL515-99229OtherBLUE CROSS
AL515-31169OtherBCBS AL
AL009934351Medicaid