Provider Demographics
NPI:1750339032
Name:GRIFFITH, DANIEL T (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:T
Last Name:GRIFFITH
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 1:2214 E HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610
Mailing Address - Country:US
Mailing Address - Phone:813-710-5001
Mailing Address - Fax:813-710-5001
Practice Address - Street 1:2701 W BUSCH BLVD STE 144
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4578
Practice Address - Country:US
Practice Address - Phone:813-452-5000
Practice Address - Fax:813-710-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87491207K00000X, 207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBW547AOtherMEDICARE PTAN
FLBW547AOtherMEDICARE PTAN