Provider Demographics
NPI:1588982003
Name:DODOBARA-GRIFFITH, LISA MIDORI (D O)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MIDORI
Last Name:DODOBARA-GRIFFITH
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 76 BLDG 99
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319-0037
Mailing Address - Country:US
Mailing Address - Phone:315-226-6200
Mailing Address - Fax:
Practice Address - Street 1:35TH MEDICAL GROUP, MISAWA AIR BASE, JAPAN
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96319-0037
Practice Address - Country:US
Practice Address - Phone:315-226-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60241084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine