Provider Demographics
NPI:1386614709
Name:GRIFFIN, GAIL T (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:T
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 COUNTY ROAD 101 N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-2307
Mailing Address - Country:US
Mailing Address - Phone:952-993-8955
Mailing Address - Fax:
Practice Address - Street 1:4155 COUNTY ROAD 101 N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446
Practice Address - Country:US
Practice Address - Phone:952-993-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTD0055104207Q00000X
MN63350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2323674OtherUNITED
MD478201100Medicaid
610101-01OtherCAREFIRST BCBS MARYLAND
3019264OtherAETNA PVN
W567-0010OtherCAREFIRST BCBS GHMSI
610101-01OtherCAREFIRST BCBS MARYLAND
MDE17372Medicare UPIN
638ZMedicare PIN