Provider Demographics
NPI:1184642282
Name:MARTINEZ, RODOLFO E (MD)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:E
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 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5228
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4101 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1121
Practice Address - Country:US
Practice Address - Phone:806-725-8000
Practice Address - Fax:806-723-6142
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM88-219207RX0202X
TXG6211207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081556501Medicaid
2318892OtherBLUE LINK
NM16774Medicaid
83G986OtherBCBS
150003OtherHMO BLUE
TX081556501Medicaid
150003OtherHMO BLUE
83G986OtherBCBS
0553280001Medicare NSC