Provider Demographics
NPI:1366762676
Name:MARTIN, SCOTT KENNETH (PA)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:KENNETH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1014 SAINT CLAIR BLVD STE 1020
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5027
Mailing Address - Country:US
Mailing Address - Phone:225-743-2000
Mailing Address - Fax:225-743-2010
Practice Address - Street 1:1014 SAINT CLAIR BLVD STE 1020
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5027
Practice Address - Country:US
Practice Address - Phone:225-743-2000
Practice Address - Fax:224-743-2010
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200388.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant