Provider Demographics
NPI:1609943836
Name:GRIFFITH, DON MARKLEY (DPM)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:MARKLEY
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LYNCH CREEK WY
Mailing Address - Street 2:#3
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-763-2253
Mailing Address - Fax:707-763-7030
Practice Address - Street 1:108 LYNCH CREEK WY
Practice Address - Street 2:#3
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-763-2253
Practice Address - Fax:707-763-7030
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E12550213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
03053OtherSAN QUENTIN IDENTIFIER
10952612OtherCAQH
10952612OtherCAQH
03053OtherSAN QUENTIN IDENTIFIER
10952612OtherCAQH