Provider Demographics
NPI:1992711436
Name:MARTINEZ, IGNACIO G (MD)
Entity type:Individual
Prefix:DR
First Name:IGNACIO
Middle Name:G
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:34 HWY 518 BONITA ESATES # 9
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701
Mailing Address - Country:US
Mailing Address - Phone:505-425-5864
Mailing Address - Fax:505-425-5864
Practice Address - Street 1:102 E HIGH ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2726
Practice Address - Country:US
Practice Address - Phone:505-461-6200
Practice Address - Fax:505-461-0404
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM85-652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27268Medicaid