Basic Information
| Provider Information | |||||||||
| NPI: | 1154358638 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | RICARDO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 TURTLE CREEK | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035963588 | ||||||||
| FaxNumber: | 9035942038 | ||||||||
| Practice Location | |||||||||
| Address1: | 5875 SOUTH HWY. 37 | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035696124 | ||||||||
| FaxNumber: | 9035692467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 01/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | J5108 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | J5108 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110230674 | 01 | TX | RAILROAD MEDICARE | OTHER | 88659G | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |