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NPI Code Detail

MEDICARE: MR. SCOTT KENNETH MARTIN PA

MEDICARE: MR. SCOTT KENNETH MARTIN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA.200388.RXLA

General Provider Information

NPI Number : 1366762676
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT KENNETH MARTIN PA
Provider Business Mailing Address
First Line : 1014 SAINT CLAIR BLVD STE 1020
Second Line :
City : GONZALES
State : LA
Zip : 70737-5027
Country : US
Telephone Number : 225-743-2000
Fax Number : 225-743-2010
Provider Business Practice Location Address
First Line : 1014 SAINT CLAIR BLVD STE 1020
Second Line :
City : GONZALES
State : LA
Zip : 70737-5027
Country : US
Telephone Number : 225-743-2000
Fax Number : 224-743-2010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2010
Last Update Date : 03/07/2022

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Directions to “ MR. SCOTT KENNETH MARTIN PA” Practice Location

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