Provider Demographics
NPI:1992714158
Name:MARTINEZ, GAUDENCIO PERALTA JR (MD)
Entity type:Individual
Prefix:DR
First Name:GAUDENCIO
Middle Name:PERALTA
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:6821 JOSHUA TREE CT
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1711
Mailing Address - Country:US
Mailing Address - Phone:269-873-6019
Mailing Address - Fax:
Practice Address - Street 1:200 ORLEANS BLVD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1767
Practice Address - Country:US
Practice Address - Phone:517-278-2129
Practice Address - Fax:517-279-8172
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-01-31
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Provider Licenses
StateLicense IDTaxonomies
MI43014018842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry