Provider Demographics
NPI:1417155078
Name:HOUSE, JOHN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:HOUSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:105 PASSION PLAY RD STE C
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-9342
Mailing Address - Country:US
Mailing Address - Phone:479-927-1100
Mailing Address - Fax:833-984-3479
Practice Address - Street 1:105 PASSION PLAY RD STE C
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-9342
Practice Address - Country:US
Practice Address - Phone:479-927-1100
Practice Address - Fax:833-984-3479
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-5931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184782001Medicaid
AR771115402OtherBREASTCARE
AR1417155078Medicare UPIN