Provider Demographics
NPI:1245206358
Name:GRIFFIN, BASIL MANLY III (MD)
Entity Type:Individual
Prefix:DR
First Name:BASIL
Middle Name:MANLY
Last Name:GRIFFIN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1304
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-1304
Mailing Address - Country:US
Mailing Address - Phone:509-292-2700
Mailing Address - Fax:509-292-9700
Practice Address - Street 1:23 E. CRAWFORD AVE.
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-5024
Practice Address - Country:US
Practice Address - Phone:509-276-2554
Practice Address - Fax:509-276-2564
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2011-08-17
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Provider Licenses
StateLicense IDTaxonomies
SC22640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1245206358Medicaid
WAG8893309Medicare PIN