Provider Demographics
NPI:1538286208
Name:SASSER, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:SASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W PORTLAND ST UNIT 821
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-5440
Mailing Address - Country:US
Mailing Address - Phone:209-324-8725
Mailing Address - Fax:
Practice Address - Street 1:200 W PORTLAND ST UNIT 821
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-5440
Practice Address - Country:US
Practice Address - Phone:209-324-8725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53609207P00000X
WI64744207P00000X
NMMD2015-0838207P00000X
SC1200717207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2656515 00Medicaid
CA00C527410Medicaid
SCTL35304OtherSTATE LICENSE
CA00C527411Medicare PIN
FL2656515 00Medicaid
CA00C527410Medicare PIN