Healthcare Provider Details

I. General information

NPI: 1588669402
Provider Name (Legal Business Name): MARTIN J SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MARENGO ST
FLORENCE AL
35630-6033
US

IV. Provider business mailing address

PO BOX 786
BIRMINGHAM AL
35201-0786
US

V. Phone/Fax

Practice location:
  • Phone: 866-313-5265
  • Fax: 205-313-5298
Mailing address:
  • Phone: 866-313-5265
  • Fax: 205-313-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number16668
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16668
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: