Provider Demographics
NPI:1932130820
Name:GRIFFIN, DUANE EDWARD (MPAS)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:EDWARD
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 NE LOOP 410
Mailing Address - Street 2:SUITE 950
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5832
Mailing Address - Country:US
Mailing Address - Phone:210-805-9800
Mailing Address - Fax:210-805-8770
Practice Address - Street 1:5364 FREDERICKSBURG RD BLDG D
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6188
Practice Address - Country:US
Practice Address - Phone:210-546-1440
Practice Address - Fax:210-546-1449
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A2804OtherBCBS
TX7460535OtherBLUELINK
TX8A2804OtherBCBS
TXS60535Medicare UPIN