Provider Demographics
NPI:1417937053
Name:MARTINEZ, HENRY DAVID (PA)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:DAVID
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4659 COHEN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4430
Mailing Address - Country:US
Mailing Address - Phone:915-751-1152
Mailing Address - Fax:915-751-1161
Practice Address - Street 1:6115 NEW COPELAND RD STE 440
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6360
Practice Address - Country:US
Practice Address - Phone:903-405-2055
Practice Address - Fax:915-751-1161
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA16886363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1432UMedicare ID - Type Unspecified
FLP99171Medicare UPIN