Provider Demographics
NPI:1487632220
Name:MARTIN, JUAN ENRIQUE JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ENRIQUE
Last Name:MARTIN
Suffix:JR
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 1:5320 S. RAINBOW BLVD.
Mailing Address - Street 2:STE 282
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-737-3808
Mailing Address - Fax:702-737-0154
Practice Address - Street 1:5320 S. RAINBOW BLVD.
Practice Address - Street 2:STE 282
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-737-3808
Practice Address - Fax:702-737-0154
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7379208G00000X
NV11049208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019383Medicaid
NV78WCKDD07Medicare PIN
NVC18856Medicare UPIN
C18856Medicare UPIN
NV002019383Medicaid