Provider Demographics
NPI:1295850865
Name:ANGEL MARTINEZ M.D. FAMILY PRACTICE CLINIC PA
Entity Type:Organization
Organization Name:ANGEL MARTINEZ M.D. FAMILY PRACTICE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-775-5600
Mailing Address - Street 1:712 N BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4111
Mailing Address - Country:US
Mailing Address - Phone:830-775-5600
Mailing Address - Fax:830-775-5699
Practice Address - Street 1:712 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4111
Practice Address - Country:US
Practice Address - Phone:830-775-5600
Practice Address - Fax:830-775-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00738YMedicare PIN
TXE05108Medicare UPIN