Provider Demographics
NPI:1093705311
Name:MARTINEZ, YANIRE C (MD)
Entity Type:Individual
Prefix:
First Name:YANIRE
Middle Name:C
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S CREEK DR
Mailing Address - Street 2:STE 102
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9472
Mailing Address - Country:US
Mailing Address - Phone:606-348-3365
Mailing Address - Fax:606-348-8496
Practice Address - Street 1:1 S CREEK DR
Practice Address - Street 2:STE 102
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9472
Practice Address - Country:US
Practice Address - Phone:606-348-3365
Practice Address - Fax:606-348-8496
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY33040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64054513Medicaid
KY64054513Medicaid
KY1282115Medicare PIN