Provider Demographics
NPI:1942267323
Name:GRIFFIN, JOE ALLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:ALLEN
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0589
Mailing Address - Country:US
Mailing Address - Phone:928-729-8000
Mailing Address - Fax:505-751-5718
Practice Address - Street 1:CORNER OF N12 AND N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-0589
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:505-751-5718
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-11-03
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-28
Provider Licenses
StateLicense IDTaxonomies
NMR16511367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R13479Medicare UPIN
343627904Medicare PIN