Healthcare Provider Details

I. General information

NPI: 1558551127
Provider Name (Legal Business Name): THOMAS WADE MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 PATTON CHAPEL RD SUITE 200
HOOVER AL
35216-5782
US

IV. Provider business mailing address

2010 PATTON CHAPEL RD SUITE 200
HOOVER AL
35216-5782
US

V. Phone/Fax

Practice location:
  • Phone: 205-208-9001
  • Fax: 205-208-0031
Mailing address:
  • Phone: 205-208-9001
  • Fax: 205-208-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD27909
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberBP20028797
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number27909
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberBP20028797
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD27909
License Number StateAL
# 6
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number27909
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: