Provider Demographics
NPI:1326185414
Name:OBEN MARTINEZ, JORGE ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ENRIQUE
Last Name:OBEN 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 1857
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1857
Mailing Address - Country:US
Mailing Address - Phone:787-831-4040
Mailing Address - Fax:787-831-4005
Practice Address - Street 1:CONDOMINIO MEDICOS DE DIEGO
Practice Address - Street 2:DE DIEGO #14 ESTE OFIC.104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-4040
Practice Address - Fax:787-831-4005
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7481207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-77667Medicare UPIN
PR0029039Medicare PIN