Provider Demographics
NPI:1609985936
Name:MARTINEZ, JOSE S (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:S
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:PMG PEDIATRIC INTENSIVISTS
Practice Address - Street 2:PRESBYTERIAN HOSPITAL 1100 CENTRAL AVE SE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-841-1163
Practice Address - Fax:505-724-7043
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-08-14
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Provider Licenses
StateLicense IDTaxonomies
NM94-322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28846Medicaid
D46031Medicare UPIN
NM28846Medicaid