Individual
DR. KELLY MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5251 W HIGHWAY 290, AUSTIN, TX 78735-8963
(512) 654-3000
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J7574
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001GP
BCBS
TX
05
—
142699101
—
TX
05
—
142699102
—
TX
05
—
142699103
—
TX
01
—
P01296379
RAILROAD MEDICARE
TX
Enumeration date
04/28/2006
Last updated
02/23/2022
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