Healthcare Provider Details

I. General information

NPI: 1295911030
Provider Name (Legal Business Name): PATRICK JAMES ROSCETTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13991 W. GRAND AVE, SUITE 105
SURPRISE AZ
85374
US

IV. Provider business mailing address

25500 N. NORTERRA PARKWAY, BLDG. B
PHOENIX AZ
85085
US

V. Phone/Fax

Practice location:
  • Phone: 623-455-7800
  • Fax: 623-455-7840
Mailing address:
  • Phone: 623-277-1000
  • Fax: 623-876-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81723
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42041
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: