Provider Demographics
NPI:1477569523
Name:GRIFFITH, DORA Y (PA-C)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:Y
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2768 PHARMACY RD
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6201
Mailing Address - Country:US
Mailing Address - Phone:956-487-5621
Mailing Address - Fax:956-487-5862
Practice Address - Street 1:2768 PHARMACY RD
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6201
Practice Address - Country:US
Practice Address - Phone:956-487-5621
Practice Address - Fax:956-487-5862
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00361363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126933404Medicaid
TX126933404Medicaid
TXP46657Medicare UPIN
TX86N736Medicare PIN