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General NPI Number Information
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NPI Number | 1225144439
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Entity Type | Organization
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Legal Business Name | REYNALDO R. MARTINEZ MD LLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 313 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 575-622-2882
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Fax | 575-622-2883
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | ROSWELL
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State | NM
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Zip | 88202
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Country | US
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Telephone | 575-622-2882
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Fax | 575-622-2883
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORI MARTINEZ
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Credential |
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Telephone | 575-622-2882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2002-0070
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License Number State | NM
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