Provider Demographics
NPI:1275660920
Name:MARTINEZ, JUAN MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MANUEL
Last Name: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:PO BOX 4340
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-4340
Mailing Address - Country:US
Mailing Address - Phone:956-548-0335
Mailing Address - Fax:956-548-0688
Practice Address - Street 1:831 RIDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8645
Practice Address - Country:US
Practice Address - Phone:956-548-0335
Practice Address - Fax:956-548-0688
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035490401Medicaid
TX035490401Medicaid
TX00QK93Medicare ID - Type Unspecified