Provider Demographics
NPI:1154358638
Name:MARTINEZ, JOSE RICARDO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RICARDO
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-2604
Mailing Address - Country:US
Mailing Address - Phone:903-342-3355
Mailing Address - Fax:903-342-3350
Practice Address - Street 1:209 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-2604
Practice Address - Country:US
Practice Address - Phone:903-342-3355
Practice Address - Fax:903-342-3350
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5108207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110230674OtherRAILROAD MEDICARE
TX88659GOtherBLUE CROSS BLUE SHIELD
TX88659GOtherBLUE CROSS BLUE SHIELD
TX8L3351Medicare PIN
G43556Medicare UPIN