Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A82100 | CA |
NPI | 1114933827 |
---|---|
Provider Name | Dr. John Robert Griffin |
First Address | Los Altos, CA 94022-1408 |
Second Address | San Mateo, CA 94401-3857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 22/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H89500 | (02) | CA |