Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 00807 | IA |
Y | 103T00000X | Psychologist | 00807 | IA |
N | 103TH0100X | Health Service | 00337 | IA |
NPI | 1336159276 |
---|---|
Provider Name | James J Griffin |
First Address | Toddville, IA 52341-9726 |
Second Address | Toddville, IA 52341-9726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 20/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23629 | WELLMARK (01) | IA |