Provider Demographics
NPI:1780907618
Name:MARTINEZ, JOHN (SOIDC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 559 BOX 6007
Mailing Address - Street 2:
Mailing Address - City:FPO/AP
Mailing Address - State:OKINAWA
Mailing Address - Zip Code:96377
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 559 BOX 6007
Practice Address - Street 2:
Practice Address - City:FPO/AP
Practice Address - State:OKINAWA
Practice Address - Zip Code:96377
Practice Address - Country:JP
Practice Address - Phone:315-625-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman