Provider Demographics
NPI:1740387844
Name:GRIFFEN, MICHAEL BRENT (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRENT
Last Name:GRIFFEN
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 1:1221 ANTILLES LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4506
Mailing Address - Country:US
Mailing Address - Phone:813-629-0604
Mailing Address - Fax:
Practice Address - Street 1:1221 ANTILLES LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4506
Practice Address - Country:US
Practice Address - Phone:813-629-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10247208000000X
MT11145208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics