Provider Demographics
NPI:1992799399
Name:GRIFFIN, JOSEPH BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BENJAMIN
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 1:793 E FOOTHILL BLVD
Mailing Address - Street 2:PMB 135
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1615
Mailing Address - Country:US
Mailing Address - Phone:805-543-5908
Mailing Address - Fax:805-543-3063
Practice Address - Street 1:865 AEROVISTA PL
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7901
Practice Address - Country:US
Practice Address - Phone:805-543-5908
Practice Address - Fax:805-543-3063
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0663322081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G663320Medicaid
CA00G663320OtherBLUE SHIELD PIN
468OtherCMSP
169299OtherCCS & GHPP
WG66332CMedicare PIN
CAD87674Medicare UPIN
468OtherCMSP