Provider Demographics
NPI:1780638577
Name:GRIFFIN, DENISE KATHRYN (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:KATHRYN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6101 WEBB RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2872
Mailing Address - Country:US
Mailing Address - Phone:813-249-0922
Mailing Address - Fax:813-886-3903
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:SUITE 210
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-249-0922
Practice Address - Fax:813-886-3903
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY499652084N0400X
FLME006477272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377841000Medicaid
KY7100448570Medicaid
IN300001695Medicaid
KY7100448570Medicaid
FL377841000Medicaid
KYK219340Medicare PIN