Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 15671 | NV |
N | 2081P2900X | Pain Medicine | A94122 | CA |
NPI | 1386622462 |
---|---|
Provider Name | Dr. Scott Matthew Martin |
First Address | Henderson, NV 89052-4434 |
Second Address | Henderson, NV 89052-4434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 07/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A94122 | CA LICENCE (01) | CA |