Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | M7454 | ID |
NPI | 1326079609 |
---|---|
Provider Name | Dr. Russell Hugh Griffiths |
First Address | Boise, ID 83716-8612 |
Second Address | Boise, ID 83712-6223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |