MEDICARE: D TODD GRIFFITH MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	2083A0300X	Addiction Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1134740400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D TODD GRIFFITH MD LLC

Provider Business Mailing Address
First Line	:	5004 E FOWLER AVE # C113
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-2181
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 W BUSCH BLVD STE 144
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4578
Country	:	US
Telephone Number	:	813-452-5000
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DANIEL T GRIFFITH
Credential	:	MD
Telephone Number	:	813-452-5000

Provider Enumeration Date	:	04/28/2020
Last Update Date	:	07/27/2020

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