Provider Demographics
NPI:1578675534
Name:WALTER G GRIFFITH JR MD PA
Entity Type:Organization
Organization Name:WALTER G GRIFFITH JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:727-577-1203
Mailing Address - Street 1:PO BOX 55156
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33732-5156
Mailing Address - Country:US
Mailing Address - Phone:727-577-1203
Mailing Address - Fax:727-577-0983
Practice Address - Street 1:5565 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1203
Practice Address - Country:US
Practice Address - Phone:727-577-1203
Practice Address - Fax:727-577-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME619132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AO433Medicare PIN