Provider Demographics
NPI:1972508133
Name:GRIFFIN, LARRY PAUL (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:PAUL
Last Name:GRIFFIN
Suffix:
Gender:M
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4130 DUTCHMANS LN
Practice Address - Street 2:STE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4711
Practice Address - Country:US
Practice Address - Phone:502-897-0697
Practice Address - Fax:502-897-0658
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17396207VM0101X
DCMD21040207VM0101X
IN01035329A207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2112000000044474OtherBLUE CROSS/BLUE SHIELD
KY50036611OtherPASSPORT - WS
KY2258716OtherAETNA
KY610673930SOtherHUMANA
KY64173966Medicaid
KY1097322OtherPASSPORT
KY0700557OtherUNITED HEALTHCARE
KY610673930SOtherHUMANA
KYK031610Medicare PIN
KY1097322OtherPASSPORT