Basic Information
| Provider Information | |||||||||
| NPI: | 1972688836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKHAM | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3192 WILLOW CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863016610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284451234 | ||||||||
| FaxNumber: | 9287783999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 WILLOW CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863011108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287783950 | ||||||||
| FaxNumber: | 9287783999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 4498 | AZ | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 4498 | 01 | AZ | PHYSICIAN MEDICAL LICENSE | OTHER | 49779 | 01 | AZ | AVESIS | OTHER | 190721 | 05 | AZ | MEDICAID | NNP12599 | 01 | AZ | UNIVERSAL HEALTH CARE | OTHER | 572818 | 01 | RAN & AMN | OTHER | 7442967 | 01 | AETNA | OTHER | 033176-001 | 01 | MERCYCARE | OTHER | 190721 | 01 | AHCCCS | OTHER | 866291-9714 | 01 | HUMANA | OTHER | A00148 | 01 | AZ | EYEMED | OTHER | DM2NNP | 01 | ARIZONA FOUNDATION | OTHER | 2Z6546 | 01 | HEALTHNET | OTHER | 3421045 | 01 | CIGNA | OTHER | 03-C0001215 | 01 | AZ | MEDICARE CCN | OTHER | 860427082 | 01 | AZ | TAX ID | OTHER |