Provider Demographics
NPI:1942394689
Name:MARTIN, ELIZABETH S (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5346 STADIUM TRACE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4582
Mailing Address - Country:US
Mailing Address - Phone:205-682-8022
Mailing Address - Fax:205-682-9446
Practice Address - Street 1:5346 STADIUM TRACE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4582
Practice Address - Country:US
Practice Address - Phone:205-682-8022
Practice Address - Fax:205-682-9446
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21915207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009960680Medicaid
H42552Medicare UPIN
ALH42552OtherHEALTH SPRING OF ALABAMA
AL051503097Medicare ID - Type Unspecified