Provider Demographics
NPI:1215923750
Name:GRIFFIN, DOUGLAS (DPM)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 E. ARBOR AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5235
Mailing Address - Country:US
Mailing Address - Phone:480-924-1552
Mailing Address - Fax:480-830-8417
Practice Address - Street 1:6116 E. ARBOR AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5235
Practice Address - Country:US
Practice Address - Phone:480-924-1552
Practice Address - Fax:480-830-8417
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000516213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480032589OtherMEDICARE RAILROAD
AZ793829Medicaid
AZAZ0194950OtherBCBS
AZ0744550001Medicare NSC
AZZ75818Medicare PIN
AZAZ0194950OtherBCBS
AZZWMBSTMedicare PIN