Provider Demographics
NPI:1700863420
Name:MARTINEZ DURAN, CARLOS E (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:E
Last Name:MARTINEZ DURAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70250
Mailing Address - Street 2:STE 134
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8250
Mailing Address - Country:US
Mailing Address - Phone:787-786-3592
Mailing Address - Fax:787-786-3506
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:STE 106
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-786-3592
Practice Address - Fax:787-786-3506
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
82390MAOtherSSS
82335Medicare ID - Type Unspecified
82390MAOtherSSS