Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 61485681205 | UT |
N | 207VX0000X | Obstetrician | 61485681205 | UT |
NPI | 1235191933 |
---|---|
Provider Name | Dr. John Griffith |
First Address | Vernal, UT 84078-2049 |
Second Address | Vernal, UT 84078-2049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F64806 | (02) | IL |