Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 16969 | OK |
NPI | 1003813825 |
---|---|
Provider Name | Dr. Carl Patrick Griffin |
First Address | Oklahoma City, OK 73112-4707 |
Second Address | Oklahoma City, OK 73112-4707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 20/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E73025 | (02) | OK |