Healthcare Provider Details

I. General information

NPI: 1912951195
Provider Name (Legal Business Name): PAUL A. MAERTENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CENTER STREET 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: 251-660-5792
Mailing address:
  • Phone: 251-660-5108
  • Fax: 251-660-5792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11964
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number11964
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: