Provider Demographics
NPI:1215985205
Name:GRIFFIN, GERALD DIETER (MD, PHARMD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DIETER
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD, PHARMD
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:DIETER
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHARMD
Mailing Address - Street 1:P.O. BOX HH
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942
Mailing Address - Country:US
Mailing Address - Phone:831-625-4511
Mailing Address - Fax:
Practice Address - Street 1:23625 HOLMAN HWY
Practice Address - Street 2:COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-625-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37105208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A371050Medicaid
CA00A371050Medicaid
CA00A371050Medicare PIN