Provider Demographics
NPI:1912052564
Name:GIFFIN, DAVID J (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:GIFFIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 632129
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80163-2129
Mailing Address - Country:US
Mailing Address - Phone:303-220-5502
Mailing Address - Fax:
Practice Address - Street 1:6342 S POPLAR CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4656
Practice Address - Country:US
Practice Address - Phone:303-220-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO356213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01003565Medicaid
CO01003565Medicaid
COC51993Medicare ID - Type Unspecified