Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 01029070A | IN |
N | 208D00000X | General Practice Physician | 01029070A | IN |
NPI | 1235209156 |
---|---|
Provider Name | Dr. Elmo Allen Griggs |
First Address | Bedford, IN 47421-5310 |
Second Address | Bedford, IN 47421-5310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 01/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100383060 | (05) | IN |
351129269 | COMMERCIAL INSURANCES (01) | IN |
D69764 | (02) | IN |