Healthcare Provider Details

I. General information

NPI: 1154028413
Provider Name (Legal Business Name): ROBERT D'SHAUN GROFF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 ARNOLD DR BLDG 1090
LITTLE ROCK AFB AR
72099-4933
US

IV. Provider business mailing address

1090 ARNOLD DR BLDG 1090
LITTLE ROCK AFB AR
72099-4933
US

V. Phone/Fax

Practice location:
  • Phone: 501-987-8811
  • Fax: 501-987-7340
Mailing address:
  • Phone: 501-987-8811
  • Fax: 501-987-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025017753
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: