Provider Demographics
NPI:1689677171
Name:MARTINEZ, DAGOBERTO (MDFACOG,FASC)
Entity type:Individual
Prefix:DR
First Name:DAGOBERTO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MDFACOG,FASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 E PRICE RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3531
Mailing Address - Country:US
Mailing Address - Phone:956-544-2001
Mailing Address - Fax:956-546-4567
Practice Address - Street 1:95 E PRICE RD BLDG A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3531
Practice Address - Country:US
Practice Address - Phone:956-544-2001
Practice Address - Fax:956-546-4567
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5297207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21169308513OtherBEECH ST
TX1351298-03Medicaid
TX07-00565OtherPHC/UHC
TX82G726OtherBLUE CROSS
TX1351298-03Medicaid
TX82G726Medicare PIN