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General NPI Number Information
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NPI Number | 1790930527
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Entity Type | Individual
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Provider Name | WILLIAM CHARLES GRONBERG PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2910 N 3RD AVE # 330
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City | PHOENIX
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State | AZ
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Zip | 85013-4434
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Country | US
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Telephone | 602-406-8811
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Fax | 602-406-8810
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Provider Business Mailing Address
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Address Line | 240 W THOMAS RD STE 301
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City | PHOENIX
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State | AZ
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Zip | 85013-4407
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Country | US
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Telephone | 602-406-7765
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4914
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4914
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License Number State | AZ
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