Provider Demographics
NPI:1639161649
Name:MARTINEZ, WILLIAM V JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:V
Last Name:MARTINEZ
Suffix:JR
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 1:5304 4TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5624
Mailing Address - Country:US
Mailing Address - Phone:941-744-2640
Mailing Address - Fax:941-744-2650
Practice Address - Street 1:5304 4TH AVENUE CIR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5624
Practice Address - Country:US
Practice Address - Phone:941-744-2640
Practice Address - Fax:941-744-2650
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032878208G00000X
FLME140886208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001328782Medicaid
CT780000036Medicare PIN
F55610Medicare UPIN