Provider Demographics
NPI:1013398676
Name:BERNARDO D. MARTINEZ MD FACS INC
Entity Type:Organization
Organization Name:BERNARDO D. MARTINEZ MD FACS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-382-9427
Mailing Address - Street 1:5122 HEATHERDOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2182
Mailing Address - Country:US
Mailing Address - Phone:567-868-4056
Mailing Address - Fax:419-382-9427
Practice Address - Street 1:5122 HEATHERDOWNS BLVD
Practice Address - Street 2:STE. 105
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2182
Practice Address - Country:US
Practice Address - Phone:567-868-4056
Practice Address - Fax:419-382-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350399172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00341OtherPARAMOUNT PIN