Provider Demographics
NPI:1235209156
Name:GRIGGS, ELMO ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELMO
Middle Name:ALLEN
Last Name:GRIGGS
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 1:2811 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-5310
Mailing Address - Country:US
Mailing Address - Phone:812-675-0902
Mailing Address - Fax:812-675-8251
Practice Address - Street 1:2811 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-5310
Practice Address - Country:US
Practice Address - Phone:812-675-0902
Practice Address - Fax:812-675-8251
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029070A207ZP0105X, 208D00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100383060Medicaid
IN351129269OtherCOMMERCIAL INSURANCES