Provider Demographics
NPI:1366468001
Name:CARVASON E. GRIFFITH, MD, INC.
Entity type:Organization
Organization Name:CARVASON E. GRIFFITH, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARVASON
Authorized Official - Middle Name:EMERY
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-948-4333
Mailing Address - Street 1:3330 NW 56TH ST STE 618
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4470
Mailing Address - Country:US
Mailing Address - Phone:405-948-4333
Mailing Address - Fax:405-948-4397
Practice Address - Street 1:3330 NW 56TH ST STE 618
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4470
Practice Address - Country:US
Practice Address - Phone:405-948-4333
Practice Address - Fax:405-948-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34728Medicare UPIN