Provider Demographics
NPI:1063476042
Name:SASSACK, ANDREW JOSEPH III (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:SASSACK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2425
Mailing Address - Street 2:
Mailing Address - City:SKYLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28776-2425
Mailing Address - Country:US
Mailing Address - Phone:828-575-2644
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:1521 E TANGERINE RD
Practice Address - Street 2:SUITE 311
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6225
Practice Address - Country:US
Practice Address - Phone:520-326-1266
Practice Address - Fax:520-326-2575
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ49772207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ173338OtherMEDICARE PTAN
MI0M14400Medicare ID - Type Unspecified
MI3168875Medicaid