Provider Demographics
NPI:1134104532
Name:GRIFFIN JR., THOMAS F (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:GRIFFIN JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-544-7644
Mailing Address - Fax:520-544-0548
Practice Address - Street 1:10425 N ORACLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9357
Practice Address - Country:US
Practice Address - Phone:520-544-7644
Practice Address - Fax:520-544-0548
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZG7816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ209321Medicaid
AZ209321Medicaid
AZ103684Medicare PIN