Healthcare Provider Details

I. General information

NPI: 1578564415
Provider Name (Legal Business Name): JULIET K MARKHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27SWFRAZER AVE
PENDLETON OR
97801-2147
US

IV. Provider business mailing address

PO BOX 1438
PENDLETON OR
97801-0350
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-3377
  • Fax: 541-278-2434
Mailing address:
  • Phone: 541-278-3377
  • Fax: 541-278-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28773
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD26356
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: