Individual
DR. AARON RANDALL DEGROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1515 W DEER VALLEY RD STE B106, PHOENIX, AZ 85027
(623) 248-4025
(602) 391-2617
Mailing address
1515 W DEER VALLEY RD STE B106, PHOENIX, AZ 85027-2041
(623) 248-4025
(602) 391-2617
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4105
AZ
209800000X
Legal Medicine (M.D./D.O.) Physician
4105
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4105
STATE LICENSE
AZ
05
—
945462
—
AZ
01
—
Z204694
MEDICARE
AZ
Enumeration date
11/09/2006
Last updated
08/05/2020
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