Provider Demographics
NPI: | 1013200591 |
---|---|
Name: | GRIFFIN, LAURA KAREEN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | LAURA |
Middle Name: | KAREEN |
Last Name: | GRIFFIN |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | LAURA |
Other - Middle Name: | KAREEN |
Other - Last Name: | PORTER |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 1850 N CENTRAL AVE |
Mailing Address - Street 2: | SUITE 1600 |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85004-4527 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-262-8900 |
Mailing Address - Fax: | 602-262-8890 |
Practice Address - Street 1: | 1850 N CENTRAL AVE |
Practice Address - Street 2: | SUITE 1600 |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85004-4527 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-262-8900 |
Practice Address - Fax: | 602-262-8890 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-05-17 |
Last Update Date: | 2023-04-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 390200000X | |
AZ | 52794 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | Z192792 | Medicare PIN |