Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 13747 | TX |
Y | 1223X0400X | Orthodontists | 7576 | NC |
NPI | 1033167911 |
---|---|
Provider Name | Dr. John Mark Griffies |
First Address | Raeford, NC 28376-3314 |
Second Address | Raeford, NC 28376-3298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89902Y7 | (05) | NC |
9020A | BLUE CROSS BLUE SHIELD (01) | NC |
971742 | UNITED CONCORDIA PROVIDER (01) | NC |