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Individual

DR. NICOLE MICHELLE MARTINEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
845 N NEW BALLAS CT STE 360, CREVE COEUR, MO 63141-7124
(314) 219-1247
Mailing address
845 N NEW BALLAS CT STE 360, CREVE COEUR, MO 63141-7124
(314) 219-1247

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
265640
NY
208600000X
Surgery Physician
N0250
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03504267
NY
05
102784987
PA
Enumeration date
05/23/2007
Last updated
08/11/2022
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