Provider Demographics
NPI:1548245723
Name:TONY MARTINEZ MD PA
Entity Type:Organization
Organization Name:TONY MARTINEZ MD PA
Other - Org Name:FAMILY DOCTOR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-584-8800
Mailing Address - Street 1:7005 ALAMOSA WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1542
Mailing Address - Country:US
Mailing Address - Phone:915-585-1443
Mailing Address - Fax:
Practice Address - Street 1:6955 N MESA ST
Practice Address - Street 2:STE 303C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4442
Practice Address - Country:US
Practice Address - Phone:915-751-1675
Practice Address - Fax:915-751-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085406082OtherSS
TX133420304Medicaid
OOT14FMedicare ID - Type Unspecified
C18874Medicare UPIN