Provider Demographics
NPI:1598738270
Name:MARTINEZ FERRATE, RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:MARTINEZ FERRATE
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 1:1192 E DRAPER PKWY # 404
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9356
Mailing Address - Country:US
Mailing Address - Phone:385-351-4911
Mailing Address - Fax:801-994-1393
Practice Address - Street 1:1226 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-6023
Practice Address - Country:US
Practice Address - Phone:801-432-7914
Practice Address - Fax:801-994-1393
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6149394-1205207QS1201X
UT61493941205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD7005Medicaid
05155056OtherECFMG/USMLE
BM5089481OtherDEA
05155056OtherECFMG/USMLE