Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2724 | AL |
NPI | 1003894536 |
---|---|
Provider Name | Dr. C. Allen Martin JR. |
First Address | Mobile, AL 36609-2923 |
Second Address | Mobile, AL 36609-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
453370 | UNITED CONCORDIA (01) | AL |
94321 | BCBS (01) | AL |
T68754 | (02) | AL |