Provider Demographics
NPI:1437364122
Name:MARTINEZ, ROGER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DAVID
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:CENTRAL PENINSULA GENERAL HOSPITAL 250 HOSPITAL PLACE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669
Mailing Address - Country:US
Mailing Address - Phone:907-714-4444
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL PENINSULA GENERAL HOSPITAL 250 HOSPITAL PLACE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-714-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3329207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK41144Medicaid