Provider Demographics
NPI:1265693428
Name:GRIFFETH, BRADLEY CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:CHRISTOPHER
Last Name:GRIFFETH
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 1:1545 W FLORIDA AVENUE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3814
Mailing Address - Country:US
Mailing Address - Phone:951-791-1111
Mailing Address - Fax:951-925-3606
Practice Address - Street 1:25470 MEDICAL CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4901
Practice Address - Country:US
Practice Address - Phone:866-419-3372
Practice Address - Fax:951-894-1842
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1103582085R0202X
CAA1206012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003859600Medicaid
FLFF961ZMedicare PIN