Provider Demographics
NPI:1851358808
Name:GRIFFIN, GLENN A (DO)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:A
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 81476
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-1476
Mailing Address - Country:US
Mailing Address - Phone:361-985-9500
Mailing Address - Fax:361-985-9506
Practice Address - Street 1:7121 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 310
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4938
Practice Address - Country:US
Practice Address - Phone:361-985-9500
Practice Address - Fax:361-985-9506
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2062208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139021315Medicaid
TXA66688Medicare UPIN