Provider Demographics
NPI:1215033469
Name:MARTIN, DUSTIN SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:SCOTT
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LN LAUMAN
Mailing Address - Street 2:
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-5000
Mailing Address - Country:US
Mailing Address - Phone:580-250-1740
Mailing Address - Fax:
Practice Address - Street 1:4301 MOWAY RD
Practice Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL (ATTN: RUBY PRESCOTT)
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6300
Practice Address - Country:US
Practice Address - Phone:580-458-2134
Practice Address - Fax:580-458-2314
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant