Provider Demographics
NPI:1396950051
Name:MARTELLOTTO, JOSEPH M (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:MARTELLOTTO
Suffix:
Gender:M
Credentials:DO
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 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:910 E HOUSTON ST STE 230
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8364
Practice Address - Country:US
Practice Address - Phone:903-606-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9482208100000X, 208VP0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ223656Medicaid
TX75-2616977-042OtherTRICARE TMFH
TX193219602Medicaid
TX8CU877OtherBCBS
TX75-2616977-103OtherTRICARE
TXTXB132242Medicare Oscar/Certification
TX193219602Medicaid
AZZ115725Medicare PIN