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NPI Code Detail

MEDICARE: DR. BRENT EUGENE GRIFFIN MD

MEDICARE: DR. BRENT EUGENE GRIFFIN MD
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 Physician38188MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21521690OTHERIAMEDICAL ASSISTANCE

General Provider Information

NPI Number : 1912068842
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENT EUGENE GRIFFIN MD
Provider Business Mailing Address
First Line : 7220 W 41ST ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57106-6028
Country : US
Telephone Number : 605-332-2883
Fax Number : 605-328-9620
Provider Business Practice Location Address
First Line : 300 S BRUCE ST
Second Line :
City : MARSHALL
State : MN
Zip : 56258-1934
Country : US
Telephone Number : 507-532-9661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 10/01/2018

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