Provider Demographics
NPI:1639687478
Name:MARTINEZ NEUROPHYSIOLOGY
Entity Type:Organization
Organization Name:MARTINEZ NEUROPHYSIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-821-0338
Mailing Address - Street 1:PO BOX 381723
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1723
Mailing Address - Country:US
Mailing Address - Phone:901-644-9688
Mailing Address - Fax:901-425-9072
Practice Address - Street 1:6825 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4742
Practice Address - Country:US
Practice Address - Phone:901-644-9688
Practice Address - Fax:901-425-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty