Provider Demographics
NPI:1275644585
Name:GRIFFIN, DAVID WAYNE (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SE PARK PLAZA DR STE 140
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5887
Mailing Address - Country:US
Mailing Address - Phone:360-449-7002
Mailing Address - Fax:
Practice Address - Street 1:203 SE PARK PLAZA DR STE 140
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5887
Practice Address - Country:US
Practice Address - Phone:360-449-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR DP00303213ES0131X
WAWA PO00000651213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery