1992984280 NPI number — J. ALEX MARTINEZ, M.D., P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992984280 NPI number — J. ALEX MARTINEZ, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J. ALEX MARTINEZ, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992984280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 BEE CAVE RD
Provider Second Line Business Mailing Address:
SUITE B 200
Provider Business Mailing Address City Name:
WEST LAKE HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-6465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-478-9845
Provider Business Mailing Address Fax Number:
512-478-3067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 BEE CAVE RD
Provider Second Line Business Practice Location Address:
SUITE B 200
Provider Business Practice Location Address City Name:
WEST LAKE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-6465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-478-9845
Provider Business Practice Location Address Fax Number:
512-478-3067
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
ALEJANDRO
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
512-478-9845

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  K1546 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 45D0504492 . This is a "CLIA ID#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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