Provider Demographics
NPI:1194828301
Name:GRIFFITH, PATRICK W (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:W
Last Name:GRIFFITH
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 1:1902 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3628
Mailing Address - Country:US
Mailing Address - Phone:337-824-9119
Mailing Address - Fax:337-824-7005
Practice Address - Street 1:1902 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3628
Practice Address - Country:US
Practice Address - Phone:337-824-9119
Practice Address - Fax:337-824-7005
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1491331Medicaid
5E066Medicare ID - Type Unspecified
LA5E066CE99Medicare UPIN
G81462Medicare UPIN
LA5E065C414Medicare UPIN