Individual
JORGE A MARTINEZ
Active
Individual
JORGE A MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M6614
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010150357
REGENCE BLUE SHIELD OF ID
ID
01
—
B4117
BLUE CROSS
ID
Enumeration date
03/14/2006
Last updated
12/14/2007
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