Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 27697 | AZ |
NPI | 1376583542 |
---|---|
Provider Name | Leon J Grobler |
First Address | Peoria, AZ 85381-4846 |
Second Address | Sun City, AZ 85351-3064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
538952 | (05) | AZ |
B85560 | (02) | AZ |