Provider Demographics
NPI:1700800828
Name:MARTINEZ, KEVIN R (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:MARTINEZ
Suffix:
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 1:4228 HOUMA BLVD STE 510
Mailing Address - Street 2:SUITE 510
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3015
Mailing Address - Country:US
Mailing Address - Phone:504-454-0141
Mailing Address - Fax:
Practice Address - Street 1:4228 HOUMA BLVD STE 510
Practice Address - Street 2:SUITE 510
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3015
Practice Address - Country:US
Practice Address - Phone:504-454-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025291208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH94951Medicare UPIN
LA4F500CH22Medicare PIN
LAP00364487Medicare PIN
LA4F500Medicare PIN