Provider Demographics
NPI:1194913335
Name:MARTINEZ, JUAN C (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:MARTINEZ
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 1:15813 PAUL VEGA MD DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1434
Mailing Address - Country:US
Mailing Address - Phone:985-230-7440
Mailing Address - Fax:985-230-7441
Practice Address - Street 1:15813 PAUL VEGA MD DR STE 201
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1431
Practice Address - Country:US
Practice Address - Phone:985-230-7440
Practice Address - Fax:985-230-7441
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAGETP.201428390200000X
LA307204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program