Provider Demographics
NPI:1659466118
Name:GRIFFIN, DARRELL ALTON (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:ALTON
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:PO BOX 58866
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8866
Mailing Address - Country:US
Mailing Address - Phone:281-338-4000
Mailing Address - Fax:281-324-6155
Practice Address - Street 1:2171 SILVER MOON TRAIL
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532
Practice Address - Country:US
Practice Address - Phone:281-338-4000
Practice Address - Fax:281-324-6155
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100238803Medicaid
TXC16304Medicare UPIN
TX8063B0Medicare PIN