Healthcare Provider Details

I. General information

NPI: 1205107489
Provider Name (Legal Business Name): WILLIAM M GRIFFIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9707
US

IV. Provider business mailing address

4301 NORTH STAR WAY
MODESTO CA
95356-9262
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-3521
  • Fax:
Mailing address:
  • Phone: 209-342-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM M GRIFFIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-342-2300