Provider Demographics
NPI:1841992039
Name:GRIFFIN, SAMUEL TODD
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:TODD
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 1:2017 S GRAND BLVD APT 305
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1512
Mailing Address - Country:US
Mailing Address - Phone:618-980-5658
Mailing Address - Fax:
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:ML 515
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0515
Practice Address - Country:US
Practice Address - Phone:513-558-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program