Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 13783 | NV |
N | 2086S0129X | Vascular Surgeon | MD23440 | OR |
NPI | 1104834639 |
---|---|
Provider Name | John Marshall Ham |
First Address | Las Vegas, NV 89102-2325 |
Second Address | Las Vegas, NV 89102-2342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
287336 | (05) | OR |
C04260 | (02) |