Provider Demographics
NPI:1053473421
Name:BROZ, ROBIN (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:BROZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8189
Mailing Address - Country:US
Mailing Address - Phone:623-241-9026
Mailing Address - Fax:
Practice Address - Street 1:8801 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8189
Practice Address - Country:US
Practice Address - Phone:623-241-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1209208000000X
AZ4074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ864480OtherAHCCCS
SD1053473421OtherWELLMARK
SD6702500Medicaid
SD1053473421OtherWELLMARK