MEDICARE: DR. HENRY ENOC MARTINEZ M.D.

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	208600000X	Surgery Physician	L4560	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447248125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY ENOC MARTINEZ M.D.

Provider Business Mailing Address
First Line	:	201 OAK DR S
Second Line	:	SUITE 202
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5676
Country	:	US
Telephone Number	:	979-297-3098
Fax Number	:	979-297-1180

Provider Business Practice Location Address
First Line	:	201 OAK DR S
Second Line	:	SUITE 202
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5676
Country	:	US
Telephone Number	:	979-297-3098
Fax Number	:	979-297-1180

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	05/01/2019

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