Provider Demographics
NPI:1588632236
Name:GRIFFIN, ROBERT J (PAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COMMONS WAY STE B
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1915
Mailing Address - Country:US
Mailing Address - Phone:406-752-5170
Mailing Address - Fax:406-752-5210
Practice Address - Street 1:200 COMMONS WAY STE B
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1915
Practice Address - Country:US
Practice Address - Phone:406-752-5170
Practice Address - Fax:406-752-5210
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY245363A00000X
MT520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S91672Medicare UPIN
20368Medicare ID - Type Unspecified