Healthcare Provider Details

I. General information

NPI: 1689615676
Provider Name (Legal Business Name): ROBERT A. MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 SHILOH DR
LAREDO TX
78045-6725
US

IV. Provider business mailing address

706 SHILOH DR
LAREDO TX
78045-6725
US

V. Phone/Fax

Practice location:
  • Phone: 956-722-8187
  • Fax:
Mailing address:
  • Phone: 956-722-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK5616
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: