Healthcare Provider Details

I. General information

NPI: 1942214598
Provider Name (Legal Business Name): GRIFFIN ORTHOPEDICS & SPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CHESTNUT ST SUITE 107
VAN BUREN AR
72956-5321
US

IV. Provider business mailing address

2020 CHESTNUT ST SUITE 107
VAN BUREN AR
72956-5321
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-8005
  • Fax: 479-474-4073
Mailing address:
  • Phone: 479-474-8005
  • Fax: 479-474-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberC8118
License Number StateAR

VIII. Authorized Official

Name: DR. FRANKIE GRIFFIN
Title or Position: DOCTOR
Credential: M.D.
Phone: 474-474-8005