Healthcare Provider Details

I. General information

NPI: 1245260322
Provider Name (Legal Business Name): MARTIN EUGENE TRUETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 HOSPITAL DR
CENTREVILLE AL
35042-2935
US

IV. Provider business mailing address

21970 HIGHWAY 216
MC CALLA AL
35111-1006
US

V. Phone/Fax

Practice location:
  • Phone: 205-926-2992
  • Fax: 205-926-2993
Mailing address:
  • Phone: 205-613-8276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number00011537
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: