Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 42066 | CO |
NPI | 1508852971 |
---|---|
Provider Name | Mark C Griffin |
First Address | Grand Junction, CO 81506-1953 |
Second Address | Grand Junction, CO 81506-1953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 13/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I02219 | (02) |