Provider Demographics
NPI:1922076082
Name:MARTINEZ, JORGE A (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 12TH AVE RD
Mailing Address - Street 2:STE B
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-7713
Mailing Address - Country:US
Mailing Address - Phone:208-498-1700
Mailing Address - Fax:208-498-1745
Practice Address - Street 1:1615 12TH AVE RD
Practice Address - Street 2:STE B
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-7713
Practice Address - Country:US
Practice Address - Phone:208-498-1700
Practice Address - Fax:208-498-1745
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM6614207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDB4117OtherBLUE CROSS
ID000010150357OtherREGENCE BLUE SHIELD OF ID
ID000010150357OtherREGENCE BLUE SHIELD OF ID
ID1126922Medicare ID - Type Unspecified
IDP00221823Medicare PIN