Healthcare Provider Details

I. General information

NPI: 1942883707
Provider Name (Legal Business Name): GRIFFIN SCOTT LERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FLORIDA AVE
MODESTO CA
95350-4422
US

IV. Provider business mailing address

15950 ROMITA CT
MONTE SERENO CA
95030-3092
US

V. Phone/Fax

Practice location:
  • Phone: 209-573-6183
  • Fax:
Mailing address:
  • Phone: 408-314-7194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: