Healthcare Provider Details

I. General information

NPI: 1740387844
Provider Name (Legal Business Name): MICHAEL BRENT GRIFFEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 ANTILLES LN
SPRING HILL FL
34606-4506
US

IV. Provider business mailing address

1221 ANTILLES LN
SPRING HILL FL
34606-4506
US

V. Phone/Fax

Practice location:
  • Phone: 813-629-0604
  • Fax:
Mailing address:
  • Phone: 813-629-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS10247
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11145
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: