Provider Demographics
NPI:1487613618
Name:MARTINEZ, RUTILO JR (MD)
Entity type:Individual
Prefix:DR
First Name:RUTILO
Middle Name:
Last Name:MARTINEZ
Suffix:JR
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 1:1900 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3942
Mailing Address - Country:US
Mailing Address - Phone:210-617-4239
Mailing Address - Fax:210-226-2854
Practice Address - Street 1:1900 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3942
Practice Address - Country:US
Practice Address - Phone:210-617-4239
Practice Address - Fax:210-226-2854
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB121256OtherWELLMED MEDICARE
TX144158602Medicaid
TX1441586-03OtherWELLMED MEDICAID
TX144158602Medicaid
TX8L6445Medicare PIN
TX8379N4Medicare ID - Type Unspecified