Healthcare Provider Details

I. General information

NPI: 1578565073
Provider Name (Legal Business Name): ANTHONY JAMES MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3856 N BLUEBONNET RD
BATON ROUGE LA
70809-2653
US

IV. Provider business mailing address

3856 N BLUEBONNET RD
BATON ROUGE LA
70809-2653
US

V. Phone/Fax

Practice location:
  • Phone: 225-663-6752
  • Fax: 225-663-6752
Mailing address:
  • Phone: 225-663-6752
  • Fax: 225-663-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME 59010
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number014768
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: