Healthcare Provider Details

I. General information

NPI: 1841238011
Provider Name (Legal Business Name): ANTHONY M. MARTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CENTER ST STE 2S
MOBILE AL
36604-1512
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-5108
  • Fax: 251-665-8299
Mailing address:
  • Phone: 251-660-5108
  • Fax: 251-665-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number26336
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: