Martinez Grullon, Juan Carlos

Martinez Grullon, Juan Carlos is an individual health care provider with primary practice located at 1250 8Th Ave Ste 265 , Fort Worth TX 76104-4124. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Plastic Surgery, Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery is his primary health care specialty. Martinez Grullon, Juan Carlos can be contacted via phone (682) 200-8580.

Contact Information

Primary practice address
1250 8Th Ave Ste 265 Fort Worth TX 76104-4124
Phone: (682) 200-8580
Fax: (682) 200-8581
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X MD448858 Pennsylvania
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X T3999 Texas
Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery 2086S0122X T3999 Texas

Profile Details

NPI number 1154589950
LBN Legal business name Martinez Grullon, Juan Carlos
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 28th, 2008
Last updated Oct 28th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154589950 NPPES
Ohio MEDICAID 0182590

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