Provider Demographics
NPI:1891714309
Name:GRIFFIN, MARSHA RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:RAE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 TREASURE HILLS BLVD # 3.14406
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8736
Mailing Address - Country:US
Mailing Address - Phone:956-296-1437
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:4150 CROSSPOINT BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-381-5817
Practice Address - Fax:956-381-5397
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1829814-04Medicaid
TXM3565OtherMEDICAL BOARD LICENSE #
TXH08GH00801OtherBCBS
TXI62001Medicare UPIN
TX182981401Medicaid