Provider Demographics
NPI:1891765616
Name:GRIFFIN, ELLIE ANNA (DO)
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:ANNA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4540 CORDATA PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8059
Mailing Address - Country:US
Mailing Address - Phone:360-676-8663
Mailing Address - Fax:360-676-8682
Practice Address - Street 1:4540 CORDATA PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8059
Practice Address - Country:US
Practice Address - Phone:360-676-8663
Practice Address - Fax:360-676-8682
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002031207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0046298OtherL&I
WA7063910Medicaid
199938OtherL&I
WA8432817Medicaid
F88657Medicare UPIN
WA8432817Medicaid
199938OtherL&I