Provider Demographics
NPI:1700328689
Name:GRIFFITH, BRADY PERRY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRADY
Middle Name:PERRY
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8959 PARTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT BONIFACIUS
Mailing Address - State:MN
Mailing Address - Zip Code:55375-1320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1752
Practice Address - Country:US
Practice Address - Phone:952-442-2191
Practice Address - Fax:952-442-6537
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12320363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical