Provider Demographics
NPI:1710983994
Name:MARTIN, JOSEPH E (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:MARTIN
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 1:4499 MEDICAL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3717
Mailing Address - Country:US
Mailing Address - Phone:210-692-0577
Mailing Address - Fax:210-692-1210
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:STE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3717
Practice Address - Country:US
Practice Address - Phone:210-692-0577
Practice Address - Fax:210-692-1210
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2019-01-14
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXD0959207VG0400X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-2011840OtherTAX IDENTIFICATION NUMBER
TXZ000T79U6Medicaid
TX74-2011840OtherTAX IDENTIFICATION NUMBER
TX83Y850Medicare ID - Type Unspecified