MEDICARE: DR. VICKI R MARTIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	14251	AL

General Provider Information

NPI Number	:	1396706586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKI R MARTIN MD

Provider Business Mailing Address
First Line	:	2018 BROOKWOOD MEDICAL CTR DR
Second Line	:	STE 315
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6898
Country	:	US
Telephone Number	:	205-877-5700
Fax Number	:	205-877-5720

Provider Business Practice Location Address
First Line	:	2018 BROOKWOOD MEDICAL CTR DR
Second Line	:	STE 315
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6898
Country	:	US
Telephone Number	:	205-877-5700
Fax Number	:	205-877-5720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	11/11/2009

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