Provider Demographics
NPI:1003813825
Name:GRIFFIN, CARL PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:PATRICK
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3555 NW 58TH ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4707
Mailing Address - Country:US
Mailing Address - Phone:405-840-7003
Mailing Address - Fax:405-840-8221
Practice Address - Street 1:3555 NW 58TH ST
Practice Address - Street 2:SUITE 801
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4707
Practice Address - Country:US
Practice Address - Phone:405-840-7003
Practice Address - Fax:405-840-8221
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK16969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE73025Medicare UPIN