MEDICARE: JESUS RICARDO MARTINEZ PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-13564	NC
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1073990784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS RICARDO MARTINEZ PA-C

Provider Business Mailing Address
First Line	:	221A PROFESSIONAL CIR
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4303
Country	:	US
Telephone Number	:	252-726-5767
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 STATION ST
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6304
Country	:	US
Telephone Number	:	910-353-0824
Fax Number	:	910-338-0068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	12/22/2025

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