Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | Q0644 | TX |
N | 207ND0900X | Dermatopathologist | Q0644 | TX |
NPI | 1548490212 |
---|---|
Provider Name | John Randall Griffin |
First Address | Pearland, TX 77584-7298 |
Second Address | Houston, TX 77057-2209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
338357202 | (05) | TX |
338357203 | (05) | TX |