Provider Demographics
NPI:1831388396
Name:MARTINEZ, TONY (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
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 1:1201 E SCHUSTER AVE
Mailing Address - Street 2:STE 3A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4646
Mailing Address - Country:US
Mailing Address - Phone:915-532-1971
Mailing Address - Fax:915-317-1841
Practice Address - Street 1:6955 N MESA ST
Practice Address - Street 2:SUITE 303C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4442
Practice Address - Country:US
Practice Address - Phone:915-584-8800
Practice Address - Fax:915-584-8356
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133420304Medicaid
00T14FMedicare PIN
C18874Medicare UPIN