Basic Information
Provider Information
NPI: 1003016742
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTINEZ
FirstName: BENJAMIN
MiddleName: SETH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 845347
Address2:  
City: DALLAS
State: TX
PostalCode: 752845347
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 5323 HARRY HINES BLVD
Address2:  
City: DALLAS
State: TX
PostalCode: 753907201
CountryCode: US
TelephoneNumber: 2146483111
FaxNumber: 2146485461
Other Information
ProviderEnumerationDate: 07/20/2007
LastUpdateDate: 08/03/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XN2187TXY Allopathic & Osteopathic PhysiciansAnesthesiology 
207R00000XN2187TXN Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
N218701TXMEDICAL LICENSEOTHER


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