Individual
LUIS GABRIEL MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
4701 LAKELAND DR APT 22B, FLOWOOD, MS 39232-9731
(817) 733-5401
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
T-4463
MS
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/29/2021
Last updated
07/01/2021
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