Provider Demographics
NPI:1124024310
Name:GRIFFIN, EUGENE RAWSON III (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:RAWSON
Last Name:GRIFFIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 17577
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7577
Mailing Address - Country:US
Mailing Address - Phone:904-399-1623
Mailing Address - Fax:904-399-1624
Practice Address - Street 1:3627 UNIVERSITY BLVD S
Practice Address - Street 2:STE 615
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-7401
Practice Address - Country:US
Practice Address - Phone:904-399-1623
Practice Address - Fax:904-399-1624
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45932207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL160053365OtherRAILROAD MEDICARE
FL10995Medicare ID - Type Unspecified
FLD45494Medicare UPIN