Healthcare Provider Details

I. General information

NPI: 1457644973
Provider Name (Legal Business Name): BRETT GROH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

543 W MYRTLE DR
CHANDLER AZ
85248-4559
US

V. Phone/Fax

Practice location:
  • Phone: 602-481-2348
  • Fax:
Mailing address:
  • Phone: 480-335-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number21649
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA066902
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4847
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-15584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: