Provider Demographics
NPI:1881716751
Name:GRIFFITH, RUSSELL FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:FREDERICK
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:PO BOX 821505
Mailing Address - Street 2:7475 SKILL MAN
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75382-1505
Mailing Address - Country:US
Mailing Address - Phone:214-341-6005
Mailing Address - Fax:
Practice Address - Street 1:7475 SKILL MAN
Practice Address - Street 2:BLDG C SUITE 103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75382-1505
Practice Address - Country:US
Practice Address - Phone:214-341-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3245207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16317Medicare UPIN
89E633Medicare ID - Type Unspecified