Provider Demographics
NPI:1407841166
Name:GROEPER, DARCIE M (DO)
Entity Type:Individual
Prefix:
First Name:DARCIE
Middle Name:M
Last Name:GROEPER
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 1:2510 W DUNLAP AVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2737
Mailing Address - Country:US
Mailing Address - Phone:602-789-0344
Mailing Address - Fax:602-789-8279
Practice Address - Street 1:2510 W DUNLAP AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2737
Practice Address - Country:US
Practice Address - Phone:602-789-0344
Practice Address - Fax:602-789-8279
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3191207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0716800OtherBCBS
AZ424250Medicaid
AZ71611Medicare ID - Type UnspecifiedPINAL COUNTY
AZ71610Medicare ID - Type UnspecifiedMARICOPA COUNTY
AZ424250Medicaid
AZ119730Medicare PIN