Provider Demographics
NPI:1902883200
Name:GRIFFITH, STEPHEN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PATRICK
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 541162
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32954-1162
Mailing Address - Country:US
Mailing Address - Phone:321-514-1774
Mailing Address - Fax:
Practice Address - Street 1:4150 S ATLANTIC AVE APT 111A
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-3761
Practice Address - Country:US
Practice Address - Phone:321-514-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME932772083B0002X, 209800000X, 208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2437858Medicaid
OHH98243Medicare UPIN
OHGR4122562Medicare ID - Type Unspecified