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NPI Code Detail

MEDICARE: DR. KYLE W. GRIFFIN M.D.

MEDICARE: DR. KYLE W. GRIFFIN M.D.
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
1207Q00000XFamily Medicine Physician2001014625MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1176566OTHERMOBCMO
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710076948
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYLE W. GRIFFIN M.D.
Provider Business Mailing Address
First Line : PO BOX 4046
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65808-4046
Country : US
Telephone Number : 417-269-5712
Fax Number : 417-269-7567
Provider Business Practice Location Address
First Line : 3800 S NATIONAL AVE STE 700
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-5279
Country : US
Telephone Number : 417-269-8817
Fax Number : 417-269-8744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 01/11/2023

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