Provider Demographics
NPI:1811217003
Name:MARTINEZ, DORA ALICIA (MD)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:ALICIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8911
Mailing Address - Country:US
Mailing Address - Phone:956-365-6750
Mailing Address - Fax:956-365-6779
Practice Address - Street 1:122 FM 506
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:TX
Practice Address - Zip Code:78593-0226
Practice Address - Country:US
Practice Address - Phone:956-365-6071
Practice Address - Fax:956-365-6072
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY LICENSE207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTEMPORARY LICENSEOtherTMB