Healthcare Provider Details

I. General information

NPI: 1548427487
Provider Name (Legal Business Name): STEPHEN RANDOLPH GRIFFITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21633 AVENUE 24
CHOWCHILLA CA
93610-9650
US

IV. Provider business mailing address

5098 N VAN NESS BLVD
FRESNO CA
93711-2850
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-6100
  • Fax: 559-665-6125
Mailing address:
  • Phone: 559-431-7465
  • Fax: 559-431-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC34670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: