Healthcare Provider Details

I. General information

NPI: 1972688836
Provider Name (Legal Business Name): SCOTT PATRICK MARKHAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 WILLOW CREEK RD
PRESCOTT AZ
86301-1108
US

IV. Provider business mailing address

3192 WILLOW CREEK RD
PRESCOTT AZ
86301-6610
US

V. Phone/Fax

Practice location:
  • Phone: 928-778-3950
  • Fax: 928-778-3999
Mailing address:
  • Phone: 928-445-1234
  • Fax: 928-778-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4498
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: