Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 49772 | AZ |
NPI | 1063476042 |
---|---|
Provider Name | Dr. Andrew Joseph Sassack III |
First Address | Skyland, NC 28776-2425 |
Second Address | Oro Valley, AZ 85755-6225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 16/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z173338 | MEDICARE PTAN (01) | AZ |