Provider Demographics
NPI:1265426407
Name:BESSETTE, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:BESSETTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3125 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1208
Mailing Address - Country:US
Mailing Address - Phone:238-829-1616
Mailing Address - Fax:623-925-0745
Practice Address - Street 1:3125 N DYSART RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1208
Practice Address - Country:US
Practice Address - Phone:623-882-9161
Practice Address - Fax:623-925-0745
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2021-02-02
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Provider Licenses
StateLicense IDTaxonomies
AZAZ18835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ287822Medicaid
AZ287822Medicaid
AZZ128048Medicare PIN