Provider Demographics
NPI:1023071974
Name:MARKHAM, JOHN WARREN (CCP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WARREN
Last Name:MARKHAM
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4523 SUGAR PINE DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2221
Mailing Address - Country:US
Mailing Address - Phone:312-420-3502
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT ROAD
Practice Address - Street 2:TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-2460
Practice Address - Fax:808-433-1558
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN