Provider Demographics
NPI:1841360484
Name:DEGROOT, AARON RANDALL (DO)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:RANDALL
Last Name:DEGROOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W DEER VALLEY RD STE B106
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2041
Mailing Address - Country:US
Mailing Address - Phone:623-248-4025
Mailing Address - Fax:602-391-2617
Practice Address - Street 1:1515 W DEER VALLEY RD STE B106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:623-248-4025
Practice Address - Fax:602-391-2617
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4105209800000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ204694OtherMEDICARE
AZ945462Medicaid
AZ4105OtherSTATE LICENSE
AZZ204694OtherMEDICARE