Provider Demographics
NPI:1578565073
Name:MARTINEZ, ANTHONY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
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 1:3856 N BLUEBONNET RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2653
Mailing Address - Country:US
Mailing Address - Phone:225-663-6752
Mailing Address - Fax:225-663-6752
Practice Address - Street 1:3856 N BLUEBONNET RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2653
Practice Address - Country:US
Practice Address - Phone:225-663-6752
Practice Address - Fax:225-663-6752
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 59010207Y00000X
LA014768207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052694100Medicaid
FL040017919OtherRAILROAD MEDICARE
LA1338150Medicaid
FLB60861Medicare UPIN
FL052694100Medicaid
FL040017919OtherRAILROAD MEDICARE