Provider Demographics
NPI:1982016267
Name:CONCIERGE BARIATRICS
Entity Type:Organization
Organization Name:CONCIERGE BARIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-236-5809
Mailing Address - Street 1:1630 SE 18TH ST
Mailing Address - Street 2:UNIT 103
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5471
Mailing Address - Country:US
Mailing Address - Phone:352-236-5809
Mailing Address - Fax:352-236-5461
Practice Address - Street 1:1630 SE 18TH ST
Practice Address - Street 2:UNIT 103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5471
Practice Address - Country:US
Practice Address - Phone:352-236-5809
Practice Address - Fax:352-236-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112612208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty