Healthcare Provider Details

I. General information

NPI: 1750339032
Provider Name (Legal Business Name): DANIEL T GRIFFITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W BUSCH BLVD STE 144
TAMPA FL
33618-4578
US

IV. Provider business mailing address

2214 E HENRY AVE
TAMPA FL
33610
US

V. Phone/Fax

Practice location:
  • Phone: 813-452-5000
  • Fax: 813-710-5001
Mailing address:
  • Phone: 813-710-5001
  • Fax: 813-710-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME87491
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME87491
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME87491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: