Provider Demographics
NPI:1649289935
Name:MARTINEZ, JOSE DE JESUS (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DE JESUS
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1905 EL MILENO DR
Mailing Address - Street 2:
Mailing Address - City:PALMHURST
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1247
Mailing Address - Country:US
Mailing Address - Phone:956-580-3350
Mailing Address - Fax:956-580-7925
Practice Address - Street 1:3512 BUDDY OWENS AVE STE 2
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5465
Practice Address - Country:US
Practice Address - Phone:956-580-3350
Practice Address - Fax:956-580-7925
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3636207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00797323OtherRR MEDICARE
TX8CG137OtherBCBS
TXI65096Medicare UPIN
TXTXB166035Medicare PIN
TXP00797323OtherRR MEDICARE