Provider Demographics
NPI:1023190071
Name:RODRIGUEZ MARTINEZ, JEPHTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEPHTE
Middle Name:
Last Name:RODRIGUEZ MARTINEZ
Suffix:
Gender:M
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:CALLE DE DIEGO E # 54
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4866
Mailing Address - Country:US
Mailing Address - Phone:787-832-6599
Mailing Address - Fax:787-832-6599
Practice Address - Street 1:CALLE DE DIEGO E # 54
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4866
Practice Address - Country:US
Practice Address - Phone:787-832-6599
Practice Address - Fax:787-832-6599
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13752208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-51143Medicare UPIN