Provider Demographics
NPI:1538168703
Name:MARTINEZ, RAUL GERARDO (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:GERARDO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2208
Mailing Address - Country:US
Mailing Address - Phone:210-805-9800
Mailing Address - Fax:210-805-8770
Practice Address - Street 1:3202 CHERRY RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4806
Practice Address - Country:US
Practice Address - Phone:210-441-4333
Practice Address - Fax:210-441-4330
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9906208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116615905Medicaid
TX116615901Medicaid
TX116615905Medicaid
TX116615901Medicaid
TX80824FMedicare PIN