Provider Demographics
NPI:1508853490
Name:MARTINEZ, JOSE LUIS (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
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 1:2140 W 68TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-822-4108
Mailing Address - Fax:786-497-2989
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-822-4108
Practice Address - Fax:305-822-5086
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065252207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28194OtherBC/BS
FL252477500Medicaid
FL252477500Medicaid
FLG49205Medicare UPIN