Provider Demographics
NPI:1588671911
Name:GRIFFIN, CHARLES BERLIN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BERLIN
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 1:8817 BELL MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-2852
Mailing Address - Country:US
Mailing Address - Phone:512-415-6090
Mailing Address - Fax:
Practice Address - Street 1:8817 BELL MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-2852
Practice Address - Country:US
Practice Address - Phone:512-415-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine