Provider Demographics
NPI:1619952900
Name:GRIFFIN, VICKY J (DO)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1151 MARGUERITE ST
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1850
Practice Address - Country:US
Practice Address - Phone:985-221-4400
Practice Address - Fax:985-221-4404
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7118207V00000X
LA301024207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA341OtherHEALTH FIRST NETWORK
AL59155862OtherBLUE CROSS BLUE SHIELD
FL44674OtherBLUE CROSS BLUE SHIELD
FL160043622OtherMEDICARE RAILROAD
FL255327900Medicaid
FL44674ZMedicare PIN
FL160043622OtherMEDICARE RAILROAD