Provider Demographics
NPI:1194988543
Name:GRIFFIN, JONATHAN SPENCER (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SPENCER
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1379
Mailing Address - Country:US
Mailing Address - Phone:808-797-1019
Mailing Address - Fax:
Practice Address - Street 1:1453 ONIONI ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3760
Practice Address - Country:US
Practice Address - Phone:808-797-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMR-1020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12731OtherMT STATE LICENSE
HIMD-22888-0OtherHI STATE LICENSE
ID808082800Medicaid