Provider Demographics
NPI:1194908517
Name:RADLEY L GRIFFIN MD PL
Entity type:Organization
Organization Name:RADLEY L GRIFFIN MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RADLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-350-9090
Mailing Address - Street 1:2420 W MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6110
Mailing Address - Country:US
Mailing Address - Phone:813-350-9090
Mailing Address - Fax:833-941-2649
Practice Address - Street 1:2420 W MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6110
Practice Address - Country:US
Practice Address - Phone:813-350-9090
Practice Address - Fax:833-941-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC013AMedicare PIN