Provider Demographics
NPI:1740290709
Name:GRIFFIN, WILLIAM LOUIS JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LOUIS
Last Name:GRIFFIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6181 N THESTA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8604
Mailing Address - Country:US
Mailing Address - Phone:559-435-6222
Mailing Address - Fax:559-435-7105
Practice Address - Street 1:6181 N THESTA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8604
Practice Address - Country:US
Practice Address - Phone:559-435-6222
Practice Address - Fax:559-435-7105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC389670207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC389670OtherSTATE LICENSES