Provider Demographics
NPI:1285615369
Name:GRIFFIN, NEIL BOSTROM (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:BOSTROM
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 1:900 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4114
Mailing Address - Country:US
Mailing Address - Phone:843-449-6414
Mailing Address - Fax:843-497-0357
Practice Address - Street 1:900 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4114
Practice Address - Country:US
Practice Address - Phone:843-449-6414
Practice Address - Fax:843-497-0357
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27314207W00000X
NC9400509207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC63789OtherMEDCOST
NC8937393Medicaid
NC0838873OtherUNITED HEALTHCARE
NC37393OtherBCBS
NCFH2000155OtherFIRSTCAROLINACARE
NC108820410OtherRAILROAD MEDICARE
NC232473OtherMAMSI
SCN00509Medicaid
SCN00509Medicaid
NC108820410OtherRAILROAD MEDICARE
NC232473OtherMAMSI
NC8937393Medicaid