=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437476421
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTT M. MARTIN MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2010
-----------------------------------------------------
Last Update Date | 04/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 JOURNEY SUITE 220
-----------------------------------------------------
City | ALISO VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92656-5336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-305-7122
-----------------------------------------------------
Fax | 949-305-7160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 JOURNEY SUITE 220
-----------------------------------------------------
City | ALISO VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92656-5336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-305-7122
-----------------------------------------------------
Fax | 949-305-7160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. SCOTT MATTHEW MARTIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-444-1413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | A94122
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------