Provider Demographics
NPI:1962535278
Name:GRIFFIN, JEFFREY BRAD (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRAD
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:509 E BYRON NELSON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6183
Mailing Address - Country:US
Mailing Address - Phone:817-491-2564
Mailing Address - Fax:817-491-3420
Practice Address - Street 1:509 E BYRON NELSON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-6183
Practice Address - Country:US
Practice Address - Phone:817-491-2564
Practice Address - Fax:817-491-3420
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA66689Medicare UPIN