Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | J4905 | TX |
N | 207KA0200X | Allergist | J4905 | TX |
NPI | 1013091586 |
---|---|
Provider Name | Dr. Miguel Juan Martinez JR. |
First Address | San Antonio, TX 78248-2345 |
Second Address | San Antonio, TX 78248-2345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 13/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0065AY | BC/BS (01) | TX |
096812502 | (05) | PR |
096812504 | (05) | TX |
BM3847158 | DEA RESGISTRATION (01) | TX |
C0085771 | DPS (01) | TX |
G16047 | (02) | TX |