Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 20020069 | NM |
Y | 208600000X | Surgeon | 20020069 | NM |
NPI | 1013029776 |
---|---|
Provider Name | Scot A Martin |
First Address | Las Cruces, NM 88011-2006 |
Second Address | Las Cruces, NM 88011-2006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 17/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00NM019760 | BCBS NM (01) | NM |
57836370 | (05) | NM |
753046022001 | MOLINA CIMARRON (01) | NM |
772805 | PRESBYTERIAN (01) | NM |
H31298 | (02) |