Provider Demographics
NPI:1821013517
Name:MARTINEZ, ALFONSO J (MD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:J
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4911 S ARROWHEAD DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055
Mailing Address - Country:US
Mailing Address - Phone:816-478-8113
Mailing Address - Fax:816-478-8108
Practice Address - Street 1:19600 E 39TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2301
Practice Address - Country:US
Practice Address - Phone:816-425-6084
Practice Address - Fax:816-873-1121
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8566207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
08700069OtherBCBS KANSAS CITY
MO201362456Medicaid
B374571BMedicare ID - Type Unspecified
E06881Medicare UPIN