Provider Demographics
NPI:1396738878
Name:GRIFFIN, DONALD LEE (MD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEE
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:PO BOX 155
Mailing Address - Street 2:CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORP.
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:14410 ROUTE 37
Practice Address - Street 2:
Practice Address - City:JOHNSTON CITY
Practice Address - State:IL
Practice Address - Zip Code:62951-3166
Practice Address - Country:US
Practice Address - Phone:618-937-6409
Practice Address - Fax:618-937-1619
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2011-10-03
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
IL036039250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
102539OtherBLACK LUNG
134108OtherHEALTHLINK
14D0685380OtherOSHA
0065382OtherUNITED MINE WROKERS FUNDS
IL036039250Medicaid
0280004028OtherBLUE CROSS BLUE SHIELD
133163200OtherDEPT OF LABOR
028221OtherHEALTH ALLIANCE
IL235810Medicare ID - Type Unspecified
0065382OtherUNITED MINE WROKERS FUNDS
102539OtherBLACK LUNG