Provider Demographics
NPI:1043633639
Name:MARTINEZ, CHAD (CRNA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SLOAN LN
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-0742
Mailing Address - Country:US
Mailing Address - Phone:936-465-4196
Mailing Address - Fax:
Practice Address - Street 1:201 SLOAN LN
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-0742
Practice Address - Country:US
Practice Address - Phone:936-465-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered