Provider Demographics
NPI:1043534662
Name:MARTINEZ, MIKE II (DO)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:MARTINEZ
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 SAINT LOUIS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-1256
Mailing Address - Country:US
Mailing Address - Phone:682-285-1044
Mailing Address - Fax:855-361-0894
Practice Address - Street 1:120 SAINT LOUIS AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1228
Practice Address - Country:US
Practice Address - Phone:682-285-1044
Practice Address - Fax:682-285-1044
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3043207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology