MEDICARE: MR. ROBERT J GRIFFIN PAC

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	363A00000X	Physician Assistant	245	WY
2	363A00000X	Physician Assistant	520	MT

General Provider Information

NPI Number	:	1588632236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT J GRIFFIN PAC

Provider Business Mailing Address
First Line	:	200 COMMONS WAY STE B
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1915
Country	:	US
Telephone Number	:	406-752-5170
Fax Number	:	406-752-5210

Provider Business Practice Location Address
First Line	:	200 COMMONS WAY STE B
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1915
Country	:	US
Telephone Number	:	406-752-5170
Fax Number	:	406-752-5210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	11/27/2023

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Directions to “ MR. ROBERT J GRIFFIN PAC” Practice Location

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