Provider Demographics
NPI:1902131501
Name:MARK BESSETTE, MD, PC
Entity Type:Organization
Organization Name:MARK BESSETTE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:BESSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-745-6513
Mailing Address - Street 1:6001 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2316
Mailing Address - Country:US
Mailing Address - Phone:520-745-6513
Mailing Address - Fax:520-733-1017
Practice Address - Street 1:6001 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2316
Practice Address - Country:US
Practice Address - Phone:520-745-6513
Practice Address - Fax:520-733-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ18835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty