Individual
DR. JUAN CARLOS MARTINEZ GRULLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1250 8TH AVE STE 265, FORT WORTH, TX 76104-4124
(682) 200-8580
(682) 200-8581
Mailing address
1250 8TH AVE, STE 265, FORT WORTH, TX 76104-4124
(682) 200-8580
(682) 200-8581
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
MD448858
PA
208200000X
Plastic Surgery Physician
T3999
TX
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
T3999
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0182590
—
OH
Enumeration date
05/28/2008
Last updated
10/28/2022
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