Healthcare Provider Details

I. General information

NPI: 1730012667
Provider Name (Legal Business Name): SCOTT WILLIAM MARTIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 NW 142ND ST
OKLAHOMA CITY OK
73134-6193
US

IV. Provider business mailing address

7600 SCARLET CIR
EDMOND OK
73025-1615
US

V. Phone/Fax

Practice location:
  • Phone: 405-492-7637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5890
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: