1831122795 NPI number — MARTY D MCDONALD DO

Table of content: MARTY D MCDONALD DO (NPI 1831122795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831122795 NPI number — MARTY D MCDONALD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONALD
Provider First Name:
MARTY
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831122795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4270 COTTAGE HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36609-4286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-300-2770
Provider Business Mailing Address Fax Number:
251-300-2771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4270 COTTAGE HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36609-4286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-300-2770
Provider Business Practice Location Address Fax Number:
251-300-2771
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  DO.734 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 515-33130 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-33134 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-13147 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009936181 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-97308 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009936182 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1831122795 . This is a "TRICARE SOUTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009909785 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009993335 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009936183 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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