Healthcare Provider Details

I. General information

NPI: 1922074277
Provider Name (Legal Business Name): DOUGLAS M MARTIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 US HIGHWAY 43
WINFIELD AL
35594-5056
US

IV. Provider business mailing address

1256 MILITARY ST S
HAMILTON AL
35570-5003
US

V. Phone/Fax

Practice location:
  • Phone: 205-487-7000
  • Fax: 205-487-7179
Mailing address:
  • Phone: 205-921-6496
  • Fax: 205-921-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO0995
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.995
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO0995
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: