Provider Demographics
NPI: | 1831330091 |
---|---|
Name: | JOE B. GRIFFIN, DPM |
Entity type: | Organization |
Organization Name: | JOE B. GRIFFIN, DPM |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SOLE PROPRIETOR/ OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GRIFFIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 251-978-9414 |
Mailing Address - Street 1: | PO BOX 1158 |
Mailing Address - Street 2: | |
Mailing Address - City: | ORANGE BEACH |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36561-1158 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 251-978-9414 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1701 N ALSTON ST |
Practice Address - Street 2: | |
Practice Address - City: | FOLEY |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36535-2246 |
Practice Address - Country: | US |
Practice Address - Phone: | 251-943-2781 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-03-18 |
Last Update Date: | 2009-03-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 510I480004 | Medicare PIN |