Healthcare Provider Details

I. General information

NPI: 1508852971
Provider Name (Legal Business Name): MARK C GRIFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 FORESIGHT CIR SUITE 200
GRAND JUNCTION CO
81505-1018
US

IV. Provider business mailing address

2515 FORESIGHT CIR UNIT 200
GRAND JUNCTION CO
81505-1156
US

V. Phone/Fax

Practice location:
  • Phone: 970-245-2400
  • Fax: 970-242-9092
Mailing address:
  • Phone: 970-245-2400
  • Fax: 970-242-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number42066
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: