Provider Demographics
NPI:1699183848
Name:NATHANIEL GRIFFITH, DO PA
Entity Type:Organization
Organization Name:NATHANIEL GRIFFITH, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:915-599-9993
Mailing Address - Street 1:1600 N LEE TREVINO DR STE C1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5164
Mailing Address - Country:US
Mailing Address - Phone:915-599-9993
Mailing Address - Fax:915-599-9050
Practice Address - Street 1:1600 N LEE TREVINO DR STE C1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5164
Practice Address - Country:US
Practice Address - Phone:915-599-9993
Practice Address - Fax:915-599-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN1658OtherTX MED LIC N1658