Provider Demographics
NPI:1568435733
Name:GRIFFIN, RADLEY LAWTON (MD)
Entity Type:Individual
Prefix:DR
First Name:RADLEY
Middle Name:LAWTON
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2420 W MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6110
Mailing Address - Country:US
Mailing Address - Phone:813-350-9090
Mailing Address - Fax:813-443-5783
Practice Address - Street 1:2420 W MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6110
Practice Address - Country:US
Practice Address - Phone:813-350-9090
Practice Address - Fax:833-941-2649
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME93435207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3409P1Medicare ID - Type Unspecified