Provider Demographics
NPI:1013166966
Name:GRIFFITH, MARTHA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 CHAD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7440
Mailing Address - Country:US
Mailing Address - Phone:541-868-9292
Mailing Address - Fax:541-687-7943
Practice Address - Street 1:3125 CHAD DR STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7440
Practice Address - Country:US
Practice Address - Phone:541-868-9292
Practice Address - Fax:541-687-7943
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00764363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA500630714Medicaid
ORPA00764OtherMEDICAL LICENSE