Provider Demographics
NPI:1851580955
Name:MARTINEZ, REYNALDO
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8816
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-0816
Mailing Address - Country:US
Mailing Address - Phone:423-262-8327
Mailing Address - Fax:423-262-8329
Practice Address - Street 1:3201 BRISTOL HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1565
Practice Address - Country:US
Practice Address - Phone:423-262-8327
Practice Address - Fax:423-262-8329
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies