Healthcare Provider Details

I. General information

NPI: 1104090737
Provider Name (Legal Business Name): JOHN R. MARKHAM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 PALOMINO ROAD
CHINO VALLEY AZ
86323
US

IV. Provider business mailing address

1680 WILLOW CREEK RD
PRESCOTT AZ
86301
US

V. Phone/Fax

Practice location:
  • Phone: 928-636-5504
  • Fax: 928-636-0780
Mailing address:
  • Phone: 928-778-3950
  • Fax: 928-778-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. SCOTT MARKHAM
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 928-778-3950