Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 10792 | MT |
NPI | 1043263593 |
---|---|
Provider Name | Douglas L Griffith |
First Address | Kalispell, MT 59901-3166 |
Second Address | Kalispell, MT 59901-3166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 08/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140403 | (05) | MT |
B56649 | (02) |