Provider Demographics
NPI:1588607444
Name:GRIFFITH, LARRY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEE
Last Name:GRIFFITH
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 1:7200 W. BELL RD
Mailing Address - Street 2:SUITE: G-103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8554
Mailing Address - Country:US
Mailing Address - Phone:623-561-7140
Mailing Address - Fax:623-561-8343
Practice Address - Street 1:7200 W. BELL RD
Practice Address - Street 2:SUITE: G-103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8554
Practice Address - Country:US
Practice Address - Phone:623-561-7140
Practice Address - Fax:623-561-8343
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ23446Medicare PIN
AZZ23447Medicare ID - Type UnspecifiedMEDICARE
AZD36955Medicare UPIN