Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | K1546 | TX |
NPI | 1164426649 |
---|---|
Provider Name | Dr. Jose Alejandro Martinez |
First Address | West Lake Hills, TX 78746-6465 |
Second Address | West Lake Hills, TX 78746-6465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 05/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1992984280 | MEDICARE IDENTIFICATION NUMBER (01) | TX |
3383651 | BLUELINK (01) | TX |
F83651 | (02) | TX |