Provider Demographics
NPI:1487833406
Name:GRIFFETH, BRIAN JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:GRIFFETH
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 1:250 N FAIRGROUNDS RD
Mailing Address - Street 2:STE. 3
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4203
Mailing Address - Country:US
Mailing Address - Phone:435-637-6797
Mailing Address - Fax:
Practice Address - Street 1:250 N FAIRGROUNDS RD
Practice Address - Street 2:STE. 3
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4203
Practice Address - Country:US
Practice Address - Phone:435-637-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005333213ES0103X
UT7365469-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00775144Medicare PIN
UT000067337Medicare PIN