Provider Demographics
NPI:1013091586
Name:MARTINEZ, MIGUEL JUAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:JUAN
Last Name:MARTINEZ
Suffix:JR
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 1:16675 HUEBNER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2345
Mailing Address - Country:US
Mailing Address - Phone:210-314-5805
Mailing Address - Fax:210-314-8626
Practice Address - Street 1:16675 HUEBNER RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2345
Practice Address - Country:US
Practice Address - Phone:210-314-5805
Practice Address - Fax:210-314-8626
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4905207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR096812502Medicaid
TX096812504Medicaid
TX0065AYOtherBC/BS
TXC0085771OtherDPS
TXC0085771OtherDPS