Provider Demographics
NPI:1013029776
Name:MARTIN, SCOT A (MD PC)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S ROADRUNNER PKWY
Mailing Address - Street 2:SUITE 129
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-2006
Mailing Address - Country:US
Mailing Address - Phone:505-521-7111
Mailing Address - Fax:505-521-0563
Practice Address - Street 1:141 S ROADRUNNER PKWY
Practice Address - Street 2:SUITE 129
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-2006
Practice Address - Country:US
Practice Address - Phone:505-521-7111
Practice Address - Fax:505-521-0563
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020069208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM019760OtherBCBS NM
NM57836370Medicaid
NM753046022001OtherMOLINA CIMARRON
NM772805OtherPRESBYTERIAN
NM753046022001OtherMOLINA CIMARRON
NM348304203Medicare ID - Type Unspecified