Provider Demographics
NPI:1578596847
Name:ROSCETTI, JAMES LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LOUIS
Last Name:ROSCETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:LOUIS
Other - Last Name:ROSCETTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1250 S CLEARVIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3378
Mailing Address - Country:US
Mailing Address - Phone:480-988-9108
Mailing Address - Fax:480-813-4460
Practice Address - Street 1:7440 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7117
Practice Address - Country:US
Practice Address - Phone:253-475-0511
Practice Address - Fax:253-475-7440
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1228907Medicaid
WAA05505Medicare UPIN
WA1228907Medicaid
WA0104590Medicare ID - Type Unspecified