Provider Demographics
NPI:1891794830
Name:MARTINEZ, ENRIQUE C (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:C
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 1:3114 A SHRINE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4745
Mailing Address - Country:US
Mailing Address - Phone:912-261-2535
Mailing Address - Fax:912-261-2508
Practice Address - Street 1:3114A SHRINE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4745
Practice Address - Country:US
Practice Address - Phone:912-261-2535
Practice Address - Fax:912-261-2508
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2014-03-27
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
GA28603207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000325531AMedicaid
GA000325531AMedicaid
GA06BDCGNMedicare ID - Type UnspecifiedMEDICARE ID NUMBER