=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538168703
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAUL GERARDO MARTINEZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2005
-----------------------------------------------------
Last Update Date | 05/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3202 CHERRY RIDGE DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-441-4333
-----------------------------------------------------
Fax | 210-441-4330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2208
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78298-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-805-9800
-----------------------------------------------------
Fax | 210-805-8770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | J9906
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------