Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101015187 | MI |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | TP120 | KY |
N | 207Q00000X | Family Doctor | 5101015187 | MI |
Y | 207Q00000X | Family Doctor | TP120 | KY |
NPI | 1326002676 |
---|---|
Provider Name | Laura E Griffin |
First Address | Pikeville, KY 41502-2917 |
Second Address | Pikeville, KY 41501-1518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 16/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100051800 | (05) | KY |
G29601 | (02) | MI |