Provider Demographics
NPI:1932206885
Name:MARTIN, RICHARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18066
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8066
Mailing Address - Country:US
Mailing Address - Phone:256-536-9300
Mailing Address - Fax:256-535-9032
Practice Address - Street 1:1963 MEMORIAL PARKWAY SW
Practice Address - Street 2:SUITE 5
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-536-9300
Practice Address - Fax:256-535-9032
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00014528207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009952090Medicaid
174148900OtherUS DEPARTMENT OF LABOR
AL51079122OtherBLUECROSS BLUESHIELD
040012221OtherRAILROAD RETIREMENT
0004310957OtherAETNA
AL51501688OtherBLUECROSS BLUESHIELD
AL51079122OtherBLUECROSS BLUESHIELD