Provider Demographics
NPI:1467581900
Name:MARTINEZ, ENRIQUE ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:ANTONIO
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 1:809 LYDIA ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2622
Mailing Address - Country:US
Mailing Address - Phone:512-499-8015
Mailing Address - Fax:512-499-0623
Practice Address - Street 1:809 LYDIA ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2622
Practice Address - Country:US
Practice Address - Phone:512-499-8015
Practice Address - Fax:512-499-0623
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1782261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC18875Medicare UPIN