Provider Demographics
NPI:1831879279
Name:VANDETTA, ALEXANDER JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JOHN
Last Name:VANDETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEC
Other - Middle Name:
Other - Last Name:VAN DETTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7400 E OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6432
Mailing Address - Country:US
Mailing Address - Phone:480-882-4000
Mailing Address - Fax:
Practice Address - Street 1:7400 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6432
Practice Address - Country:US
Practice Address - Phone:480-882-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT390200000X
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program