Provider Demographics
NPI:1609867308
Name:MARTINEZ, RICARDO DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:DAVID
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:PO BOX 2975
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2975
Mailing Address - Country:US
Mailing Address - Phone:956-362-8170
Mailing Address - Fax:956-362-8168
Practice Address - Street 1:1100 E DOVE AVE STE 300
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-362-8170
Practice Address - Fax:956-362-8168
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4906208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102434103Medicaid
TX102434102Medicaid
TX82931BMedicare ID - Type Unspecified
TX102434102Medicaid