Provider Demographics
NPI:1568726529
Name:GRIFFIN, BENJAMIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:GRIFFIN
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-8197
Mailing Address - Fax:319-356-2999
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-384-8197
Practice Address - Fax:319-356-2999
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56561207R00000X
IAMD-46392207R00000X, 207RN0300X
CODR.0058309208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
CO9000154806Medicaid
IAENROLLEDMedicaid
CO028588OtherKAISER COMMERCIAL NUMBER
MNP01234119OtherRAILROAD MEDICARE
MNENROLLEDMedicaid