Provider Demographics
NPI:1447429097
Name:RACETTE, ANDREW JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:RACETTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4801 E MCDOWELL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7725
Mailing Address - Country:US
Mailing Address - Phone:602-954-3919
Mailing Address - Fax:602-954-3670
Practice Address - Street 1:4801 E MCDOWELL RD STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7725
Practice Address - Country:US
Practice Address - Phone:602-954-3919
Practice Address - Fax:602-954-3670
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4311207NS0135X, 207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ121310Medicare PIN