Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101260236 | VA |
NPI | 1144544610 |
---|---|
Provider Name | Justin W Griffin |
First Address | Virginia Beach, VA 23462-1784 |
Second Address | Virginia Beach, VA 23462-1784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2010 |
Last Update Date | 24/10/2016 |