Most Relevant Information
Provider Data
| NPI Number: | 1003269440 |
| Provider Name: | JERRY MARTINEZ COTA |
| Entity Type: | Individual |
| Taxonomy Code: | 171W00000X |
| Specialty: | Contractor |
| License Number: | 209135 |
Most Important Dates
| Enumeration Date: | 07/21/2016 |
| Last Updated: | 07/21/2016 |
Provider Practice Location
921 E MAIN AVE STE 5
ALTON
TX
785731606
Practice Location Phone/Fax
| Phone: | 9565192500 |
| Fax: |
Provider Mailing Location
921 E MAIN AVE STE 5
ALTON
TX
785731606
Provider Mailing Phone/Fax
| Phone: | 9565192500 |
| Fax: |