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General NPI Number Information
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NPI Number | 1477313484
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Entity Type | Organization
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Legal Business Name | STOCKYARDS MEDICAL PLLC
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 120 SAINT LOUIS AVE STE 100
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City | FORT WORTH
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State | TX
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Zip | 76104-1256
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Country | US
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Telephone | 682-285-1044
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Fax |
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Provider Business Mailing Address
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Address Line | 120 SAINT LOUIS AVE STE 100
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City | FORT WORTH
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State | TX
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Zip | 76104-1256
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Country | US
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Telephone | 682-285-1044
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIKE MARTINEZ II
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Credential | DO
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Telephone | 682-285-1044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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