Provider Demographics
NPI:1366447294
Name:DEMAY, JOHN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:DEMAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2930 HAMILTON BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2431
Mailing Address - Country:US
Mailing Address - Phone:712-277-9370
Mailing Address - Fax:712-252-4733
Practice Address - Street 1:2930 HAMILTON BLVD
Practice Address - Street 2:STE 102
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2431
Practice Address - Country:US
Practice Address - Phone:712-277-9370
Practice Address - Fax:712-252-4733
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2016-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA31906207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1366447294OtherMEDICARE INDIVIDUAL NPI
IADT7736OtherMEDICARE RR GROUP PTAN
IA1417088907OtherWELLMARK GROUP NPI NUMBER
IAIB2763OtherMEDICARE GROUP PTAN
IAIB2763001OtherMEDICARE INDIVIDUAL PTAN