Provider Demographics
NPI:1992193957
Name:MCLEOD, ROBERT JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 E BAYWOOD AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1749
Mailing Address - Country:US
Mailing Address - Phone:480-543-3030
Mailing Address - Fax:480-543-3031
Practice Address - Street 1:6750 E BAYWOOD AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1749
Practice Address - Country:US
Practice Address - Phone:480-543-3030
Practice Address - Fax:480-543-3031
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74242T00000X
AZ5929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist