Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2006031050 | MO |
N | 208D00000X | General Practice Physician | 2006031050 | MO |
NPI | 1023075405 |
---|---|
Provider Name | Dr. Richard Thomas Griffey |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206969107 | (05) | MO |