Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 30-013823 | OH |
NPI | 1356484430 |
---|---|
Provider Name | Dr. Meredith Lee Griffith |
First Address | Lorain, OH 44055-3138 |
Second Address | Lorain, OH 44055-3138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0182029 | (05) | OH |