Provider Demographics
NPI:1700820602
Name:GRIFFITH, RAYMOND KENT (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:KENT
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 WEST 32ND STREET
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-347-1111
Mailing Address - Fax:417-347-2149
Practice Address - Street 1:620 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2926
Practice Address - Country:US
Practice Address - Phone:870-365-2000
Practice Address - Fax:417-347-2149
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117039207P00000X
ARE-5562207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175566003Medicaid
MO204642102Medicaid
MO243419306Medicaid
5H314OtherAR BLUE CROSS
G46294Medicare UPIN
5H314Medicare PIN
MO204642102Medicaid
MO084050049Medicare ID - Type Unspecified
MO243419306Medicaid
AR175566003Medicaid