MEDICARE: DR. CONCEPCION MARTINEZ MD

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	207V00000X	Obstetrics & Gynecology Physician	M1733	TX
2	207Q00000X	Family Medicine Physician	M1733	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M1733	OTHER	TX	TX LICENSE NUMBER

General Provider Information

NPI Number	:	1710973946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONCEPCION MARTINEZ MD

Provider Business Mailing Address
First Line	:	1045 CENTRAL PARKWAY NORTH
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5024
Country	:	US
Telephone Number	:	210-541-4500
Fax Number	:	210-541-4508

Provider Business Practice Location Address
First Line	:	414 NAVARRO ST
Second Line	:	SUITE 809
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2516
Country	:	US
Telephone Number	:	210-272-1741
Fax Number	:	210-272-1746

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	01/15/2013

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