Provider Demographics
NPI:1134103286
Name:GRIFFITH, SUE A (PA)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-7450
Mailing Address - Fax:303-494-5265
Practice Address - Street 1:1755 48TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2711
Practice Address - Country:US
Practice Address - Phone:303-415-7450
Practice Address - Fax:303-494-5265
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0000459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO970021431OtherMEDICARE RAILROAD
CO34189769Medicaid
CO34189769Medicaid
COC435038Medicare PIN