MEDICARE: DR. DAVID JOHN MARTINEZ D.O.

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	207Q00000X	Family Medicine Physician	036064805	IL

General Provider Information

NPI Number	:	1245211259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JOHN MARTINEZ D.O.

Provider Business Mailing Address
First Line	:	13707 W JACKSON ST
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3188
Country	:	US
Telephone Number	:	815-337-1871
Fax Number	:	815-338-6297

Provider Business Practice Location Address
First Line	:	3707 DOTY RD
Second Line	:	SUITE H
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-7530
Country	:	US
Telephone Number	:	815-338-6600
Fax Number	:	815-337-2898

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	05/08/2009

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