Provider Demographics
NPI:1447245469
Name:MARTINEZ-PRIETO, JORGE N (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:N
Last Name:MARTINEZ-PRIETO
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 1:303 E QUINCY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1918
Mailing Address - Country:US
Mailing Address - Phone:210-229-7242
Mailing Address - Fax:210-227-5092
Practice Address - Street 1:303 E QUINCY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1918
Practice Address - Country:US
Practice Address - Phone:210-229-7242
Practice Address - Fax:210-227-5092
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG79352084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115728103Medicaid
TX115728105Medicaid
TXG7935OtherLICENSE
TXG7935OtherLICENSE
TX8L22131Medicare PIN
TX00QB49Medicare PIN