Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | E10498 | AR |
NPI | 1407892805 |
---|---|
Provider Name | Stacy Sirmar Griffin |
First Address | Little Rock, AR 72205-4565 |
Second Address | Little Rock, AR 72205-4565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 24/05/2021 |