Provider Demographics
NPI:1972688836
Name:MARKHAM, SCOTT PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PATRICK
Last Name:MARKHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3192 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-6610
Mailing Address - Country:US
Mailing Address - Phone:928-445-1234
Mailing Address - Fax:928-778-3999
Practice Address - Street 1:1680 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1108
Practice Address - Country:US
Practice Address - Phone:928-778-3950
Practice Address - Fax:928-778-3999
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4498207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4498OtherPHYSICIAN MEDICAL LICENSE
AZ49779OtherAVESIS
AZ190721Medicaid
AZNNP12599OtherUNIVERSAL HEALTH CARE
572818OtherRAN & AMN
7442967OtherAETNA
033176-001OtherMERCYCARE
190721OtherAHCCCS
866291-9714OtherHUMANA
AZA00148OtherEYEMED
DM2NNPOtherARIZONA FOUNDATION
2Z6546OtherHEALTHNET
3421045OtherCIGNA
AZ03-C0001215OtherMEDICARE CCN
AZ860427082OtherTAX ID