MEDICARE: JOHN MARSHALL HAM MD

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
1	2086S0129X	Vascular Surgery Physician	MD23440	OR
2	2086S0129X	Vascular Surgery Physician	13783	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104834639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MARSHALL HAM MD

Provider Business Mailing Address
First Line	:	1701 W CHARLESTON BLVD
Second Line	:	#215
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2325
Country	:	US
Telephone Number	:	702-671-2395
Fax Number	:	702-382-5388

Provider Business Practice Location Address
First Line	:	1120 SHADOW LN
Second Line	:	SUITE D-100
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2342
Country	:	US
Telephone Number	:	702-383-2224
Fax Number	:	702-383-3035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/23/2021

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