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General NPI Number Information
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NPI Number | 1659364701
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Entity Type | Individual
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Provider Name | ENRIQUE MARTINEZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 255 HWY 187
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City | HATCH
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State | NM
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Zip | 87937-0370
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Country | US
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Telephone | 575-267-3088
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Fax | 575-267-4606
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Provider Business Mailing Address
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Address Line | 255 HWY 187 P.O BOX 370
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City | HATCH
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State | NM
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Zip | 87937-0370
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Country | US
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Telephone | 575-267-3280
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Fax | 575-267-1747
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 78-217
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License Number State | NM
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