Provider Demographics
NPI:1376659615
Name:GRIFFITH, BRIAN CHACE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHACE
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 1:575 S WICKHAM RD STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1170
Mailing Address - Country:US
Mailing Address - Phone:321-727-8940
Mailing Address - Fax:
Practice Address - Street 1:575 S WICKHAM RD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1170
Practice Address - Country:US
Practice Address - Phone:321-727-8940
Practice Address - Fax:321-733-7050
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137265208M00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100361000Medicaid
FLP2332OtherMEDICARE HF
FLPENDINGOtherMEDICARE