Provider Demographics
NPI:1427207802
Name:ELLIE GRIFFIN DO PS
Entity Type:Organization
Organization Name:ELLIE GRIFFIN DO PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-733-1407
Mailing Address - Street 1:1317 23RD STREET
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7231
Mailing Address - Country:US
Mailing Address - Phone:360-733-1407
Mailing Address - Fax:360-733-1407
Practice Address - Street 1:1317 23RD STREET
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7231
Practice Address - Country:US
Practice Address - Phone:360-733-1407
Practice Address - Fax:360-733-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002031204D00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty