Provider Demographics
NPI:1124134788
Name:MARTIN, RAFAEL A (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 E PRICE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3527
Mailing Address - Country:US
Mailing Address - Phone:956-548-7400
Mailing Address - Fax:956-548-7458
Practice Address - Street 1:191 E PRICE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3527
Practice Address - Country:US
Practice Address - Phone:956-548-7400
Practice Address - Fax:956-548-7458
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ067422Medicaid
TX299769401Medicaid
TXTXB153446Medicare Oscar/Certification
AZD35812Medicare UPIN
AZZ64536Medicare ID - Type UnspecifiedMEDICARE