Provider Demographics
NPI:1659440899
Name:MARTINEZ, ERICK (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
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 1:2911 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8000
Mailing Address - Country:US
Mailing Address - Phone:928-783-3050
Mailing Address - Fax:928-782-7473
Practice Address - Street 1:2911 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8000
Practice Address - Country:US
Practice Address - Phone:928-783-3050
Practice Address - Fax:928-782-7473
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20874207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ076530Medicaid
AZF09030Medicare UPIN
AZWMBKJ01Medicare ID - Type Unspecified