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General NPI Number Information
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NPI Number | 1629071337
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Entity Type | Individual
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Provider Name | AUGUSTO L MARTINEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 5932 SPRINGBORO PIKE
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City | DAYTON
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State | OH
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Zip | 45449-3250
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Country | US
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Telephone | 937-435-8663
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Fax | 937-435-8966
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Provider Business Mailing Address
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Address Line | 5932 SPRINGBORO PIKE
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City | DAYTON
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State | OH
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Zip | 45449-3250
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Country | US
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Telephone | 937-435-8663
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Fax | 937-435-8966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 35062499
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License Number State | OH
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