Healthcare Provider Details

I. General information

NPI: 1386622462
Provider Name (Legal Business Name): SCOTT MATTHEW MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 W HORIZON RIDGE PKWY
HENDERSON NV
89052-4434
US

IV. Provider business mailing address

2705 W HORIZON RIDGE PKWY
HENDERSON NV
89052-4434
US

V. Phone/Fax

Practice location:
  • Phone: 702-880-4193
  • Fax: 702-492-4719
Mailing address:
  • Phone: 702-880-4193
  • Fax: 702-492-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA94122
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number15671
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: