Provider Demographics
NPI:1700913316
Name:GRIFFIN, ROBERT CHARLES
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHARLES
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MACLEAN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-6509
Mailing Address - Country:US
Mailing Address - Phone:303-805-0865
Mailing Address - Fax:720-851-0393
Practice Address - Street 1:7 MACLEAN DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-6509
Practice Address - Country:US
Practice Address - Phone:303-805-0865
Practice Address - Fax:720-851-0393
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO116923163WM0705X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841542109OtherEMPLOYER ID NUMBER