Basic Information
| Provider Information | |||||||||
| NPI: | 1295731164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24165 IH-10 WEST, STE 217 PMB 750 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668192816 | ||||||||
| FaxNumber: | 8306326568 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 CENTRE OAK DRIVE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668192816 | ||||||||
| FaxNumber: | 8306326568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | MDH6410 | TX | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 142115801 | 05 | TX | MEDICAID | S64174 | 01 | TX | MEDICARE UPIN | OTHER | 287538701-PVA | 05 | TX | MEDICAID | 8C0434 | 01 | TX | MEDICARE W/PVA | OTHER |