Provider Demographics
NPI:1386656767
Name:SACCO, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SACCO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:150 N VERDE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5256
Mailing Address - Country:US
Mailing Address - Phone:928-779-0588
Mailing Address - Fax:928-779-2358
Practice Address - Street 1:150 N VERDE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5256
Practice Address - Country:US
Practice Address - Phone:928-779-0588
Practice Address - Fax:928-779-2358
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-02-09
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Provider Licenses
StateLicense IDTaxonomies
AZ46901207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ762610Medicaid
H70960Medicare UPIN
AZZ92989Medicare PIN