Provider Demographics
NPI:1629064720
Name:GRIFFIN, JOHN C (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:GRIFFIN
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 1:1106 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5536
Mailing Address - Country:US
Mailing Address - Phone:903-757-0525
Mailing Address - Fax:903-553-0069
Practice Address - Street 1:1106 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5536
Practice Address - Country:US
Practice Address - Phone:903-757-0525
Practice Address - Fax:903-553-0069
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0327213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F291Medicare PIN
TXT13569Medicare UPIN