Healthcare Provider Details

I. General information

NPI: 1811573686
Provider Name (Legal Business Name): JUAN GERARDO MARTINEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 ROPER LN
DAPHNE AL
36526-5274
US

IV. Provider business mailing address

700 POTOMAC ST
AURORA CO
80011-6844
US

V. Phone/Fax

Practice location:
  • Phone: 251-378-6500
  • Fax:
Mailing address:
  • Phone: 303-317-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0073637
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number3974
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: