Provider Demographics
NPI:1861503419
Name:MARKESON, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:MARKESON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1050 SOUTH MEDICAL DRIVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302
Mailing Address - Country:US
Mailing Address - Phone:435-538-1733
Mailing Address - Fax:435-538-1752
Practice Address - Street 1:1050 SOUTH MEDICAL DRIVE
Practice Address - Street 2:STE 101
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302
Practice Address - Country:US
Practice Address - Phone:435-538-1733
Practice Address - Fax:435-538-1752
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT163362-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT06065Medicaid
UTD07524Medicare UPIN