Provider Demographics
NPI:1235174244
Name:MARTINEZ, MARCOS (DO)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 INDEPENDENCE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:214-396-8877
Mailing Address - Fax:214-983-0983
Practice Address - Street 1:5350 INDEPENDENCE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:214-396-8877
Practice Address - Fax:214-983-0983
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4740207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBD3444Medicare ID - Type Unspecified
H37868Medicare UPIN