Provider Demographics
NPI:1104834639
Name:HAM, JOHN MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARSHALL
Last Name:HAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:#215
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-671-2395
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:1120 SHADOW LN
Practice Address - Street 2:SUITE D-100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2342
Practice Address - Country:US
Practice Address - Phone:702-383-2224
Practice Address - Fax:702-383-3035
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD234402086S0129X
NV137832086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287336Medicaid
OR287336Medicaid
C04260Medicare UPIN