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Individual

JORGE A MARTINEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1615 12TH AVE RD, STE B, NAMPA, ID 83686-7713
(208) 498-1700
(208) 498-1745
Mailing address
1615 12TH AVE RD, STE B, NAMPA, ID 83686-7713
(208) 498-1700
(208) 498-1745

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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