Provider Demographics
NPI:1376583542
Name:GROBLER, LEON J (MD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:J
Last Name:GROBLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-972-9590
Practice Address - Street 1:13188 N 103RD DR
Practice Address - Street 2:STE 209
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3064
Practice Address - Country:US
Practice Address - Phone:623-876-3870
Practice Address - Fax:623-815-0087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27697207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ538952Medicaid
AZ65334Medicare ID - Type UnspecifiedMDCR GRP WCKJD
AZ65338Medicare ID - Type UnspecifiedMDCR GRP WCFGW
AZB85560Medicare UPIN