Provider Demographics
NPI:1376520080
Name:MARTINEZ, OCTAVIO N JR (MD, MPH, MBA)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:N
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:MD, MPH, MBA
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 7998
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78713-7998
Mailing Address - Country:US
Mailing Address - Phone:512-471-7625
Mailing Address - Fax:
Practice Address - Street 1:3001 LAKE AUSTIN BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4200
Practice Address - Country:US
Practice Address - Phone:512-471-7625
Practice Address - Fax:512-471-9608
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK89462084P0800X
NC2006-017712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153929804Medicaid
TX8H2040OtherBCBS PROVIDER #
TX8G8010OtherBCBS PROVIDER #
TXH71838Medicare UPIN
TX8G8010OtherBCBS PROVIDER #
TX153929804Medicaid