Provider Demographics
NPI:1609261916
Name:MARTINEZ, MAXIMILIAN STEPHEN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:MAXIMILIAN
Middle Name:STEPHEN JOSEPH
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MADISON ST, SUITE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5037
Mailing Address - Country:US
Mailing Address - Phone:931-919-2820
Mailing Address - Fax:931-436-5923
Practice Address - Street 1:1810 MADISON ST, SUITE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5037
Practice Address - Country:US
Practice Address - Phone:931-919-2820
Practice Address - Fax:931-436-5923
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-45145207X00000X
NC2022-00114207X00000X
390200000X
TNMD73339207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program