Provider Demographics
NPI:1447248125
Name:MARTINEZ, HENRY ENOC (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ENOC
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 OAK DR S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5676
Mailing Address - Country:US
Mailing Address - Phone:979-297-3098
Mailing Address - Fax:979-297-1180
Practice Address - Street 1:201 OAK DR S
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5676
Practice Address - Country:US
Practice Address - Phone:979-297-3098
Practice Address - Fax:979-297-1180
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4560208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155149102Medicaid
TXH69179Medicare UPIN