Provider Demographics
NPI:1417907858
Name:MARTINEZ, JOSE G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
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 1:5925 TWO PINES TRL
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8461
Mailing Address - Country:US
Mailing Address - Phone:919-556-2704
Mailing Address - Fax:
Practice Address - Street 1:5925 TWO PINES TRL
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8461
Practice Address - Country:US
Practice Address - Phone:919-556-2704
Practice Address - Fax:919-556-2704
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045688208M00000X
NC95-00134208M00000X
MD165417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD89-54037Medicaid
NC89-54037Medicaid
MD2206985FMedicare PIN
NCG01969Medicare UPIN
MDG019609Medicare UPIN
NC89-54037Medicaid