MEDICARE: JOHN L GRIFFITH PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	61485681205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07171961	OTHER		OWNER'S BIRTHDATE

General Provider Information

NPI Number	:	1154406163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN L GRIFFITH PC

Provider Business Mailing Address
First Line	:	175 N 100 W
Second Line	:	STE 103
City	:	VERNAL
State	:	UT
Zip	:	84078-2049
Country	:	US
Telephone Number	:	435-781-1099
Fax Number	:	435-781-1090

Provider Business Practice Location Address
First Line	:	175 N 100 W
Second Line	:	STE 103
City	:	VERNAL
State	:	UT
Zip	:	84078-2049
Country	:	US
Telephone Number	:	435-781-1099
Fax Number	:	435-781-1090

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN L GRIFFITH
Credential	:	MD
Telephone Number	:	435-781-1099

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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