Provider Demographics
NPI:1588322432
Name:MARTINEZ, WILLIAMS JOSE
Entity type:Individual
Prefix:DR
First Name:WILLIAMS
Middle Name:JOSE
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 CAVENDER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-7674
Mailing Address - Country:US
Mailing Address - Phone:407-304-0635
Mailing Address - Fax:
Practice Address - Street 1:1156 CAVENDER CREEK RD
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-7674
Practice Address - Country:US
Practice Address - Phone:407-304-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPA220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTPPA220OtherPRIMARY CARE
FLTPPA220OtherTELEHEALTH