MEDICARE: BENJAMIN 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	207Q00000X	Family Medicine Physician	23493	CO

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	:	1932328663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MARTINEZ MD

Provider Business Mailing Address
First Line	:	1726 S PRAIRIE AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-2253
Country	:	US
Telephone Number	:	719-561-1291
Fax Number	:	719-561-8660

Provider Business Practice Location Address
First Line	:	1726 S PRAIRIE AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-2253
Country	:	US
Telephone Number	:	719-561-1291
Fax Number	:	719-561-8660

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	06/06/2008

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