Provider Demographics
NPI:1700804788
Name:GRIFFIN, SHAWN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:P
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5210 NORTH BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1211
Mailing Address - Country:US
Mailing Address - Phone:816-271-4996
Mailing Address - Fax:816-271-4926
Practice Address - Street 1:5210 NORTH BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-1211
Practice Address - Country:US
Practice Address - Phone:816-271-4996
Practice Address - Fax:816-271-4926
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO113444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400268OtherBLUE CROSS/BLUE SHIELD KS
KS100395630AMedicaid
MO246807846Medicaid
MO2042934OtherAETNA
MO10001084500OtherCOMMUNITY HEALTH PLAN
MO26D0896653OtherCLIA
MO24468016OtherBLUE CROSS/BLUE SHIELD KC
KS100395630AMedicaid
MO24468016OtherBLUE CROSS/BLUE SHIELD KC
MOG17878Medicare UPIN