Provider Demographics
NPI:1407971138
Name:MARTINEZ, GILBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16014 VIA SHAVANO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2364
Mailing Address - Country:US
Mailing Address - Phone:210-614-3011
Mailing Address - Fax:210-615-6906
Practice Address - Street 1:4242 MEDICAL DR
Practice Address - Street 2:SUITE 6250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5640
Practice Address - Country:US
Practice Address - Phone:210-614-3011
Practice Address - Fax:210-615-6906
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30743103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030241601Medicaid
TX0009DGOtherBLUE CROSS BLUE SHIELD
TX0009DGOtherBLUE CROSS BLUE SHIELD