Provider Demographics
NPI:1447263306
Name:SASSANO, JOHN M (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:SASSANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2701 E VICTOR HUGO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5935
Mailing Address - Country:US
Mailing Address - Phone:330-697-1634
Mailing Address - Fax:
Practice Address - Street 1:710 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3507
Practice Address - Country:US
Practice Address - Phone:800-223-3264
Practice Address - Fax:602-588-3764
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4450S207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ129574Medicaid
OH0764785Medicaid
OH0764785Medicaid