Provider Demographics
NPI:1811281140
Name:MARTINEZ, MICHAEL JOEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOEL
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:PO BOX 5358
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-5358
Mailing Address - Country:US
Mailing Address - Phone:956-362-5673
Mailing Address - Fax:
Practice Address - Street 1:533 PECAN BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2356
Practice Address - Country:US
Practice Address - Phone:956-365-4400
Practice Address - Fax:956-365-4111
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5679208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348256401Medicaid
TX426314YRZCMedicare PIN