Individual
DR. IRVIN L. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-9231
(601) 703-4352
Mailing address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
12862
MS
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
12862
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115751
—
MS
01
—
009504900
MEDICAID OF AL
AL
01
—
200021882
RAIL ROAD MEDICARE
—
01
—
73073633
BLUE CROSS OF AL
AL
Enumeration date
08/24/2005
Last updated
11/07/2013
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