Provider Demographics
NPI:1053403659
Name:JORGE MARTINEZ-LEYVA, MD
Entity type:Organization
Organization Name:JORGE MARTINEZ-LEYVA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-424-2623
Mailing Address - Street 1:PO BOX 52119
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-2119
Mailing Address - Country:US
Mailing Address - Phone:318-424-2623
Mailing Address - Fax:318-227-1357
Practice Address - Street 1:8001 YOUREE DRIVE
Practice Address - Street 2:SUITE 850
Practice Address - City:SHREVEPORT
Practice Address - State:AL
Practice Address - Zip Code:71115
Practice Address - Country:US
Practice Address - Phone:318-424-2623
Practice Address - Fax:318-227-1357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty