Provider Demographics
NPI:1245322338
Name:RICHARD E. MARTINEZ, MD AND ASSOCIATES, PA
Entity type:Organization
Organization Name:RICHARD E. MARTINEZ, MD AND ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-816-2552
Mailing Address - Street 1:1420 RIVER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1994
Mailing Address - Country:US
Mailing Address - Phone:830-816-2552
Mailing Address - Fax:830-816-3009
Practice Address - Street 1:1420 RIVER RD STE 200
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1994
Practice Address - Country:US
Practice Address - Phone:830-816-2552
Practice Address - Fax:830-816-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131711701Medicaid
TX017705701Medicaid
TX131711701Medicaid
TX00868NMedicare PIN
TX=========OtherTAX ID NUMBER