Provider Demographics
NPI:1083095541
Name:GRIFFIN, ELISE (DO)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 VIRGINIA PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4970
Mailing Address - Country:US
Mailing Address - Phone:972-542-8144
Mailing Address - Fax:972-548-9891
Practice Address - Street 1:2750 VIRGINIA PKWY STE 108
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4970
Practice Address - Country:US
Practice Address - Phone:972-542-8144
Practice Address - Fax:972-548-9891
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-104972084P0800X
390200000X
TXS41472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program