Healthcare Provider Details

I. General information

NPI: 1508508524
Provider Name (Legal Business Name): GRIFFIN VAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 S CONGRESS AVE STE 1C
WEST PALM BEACH FL
33406-7652
US

IV. Provider business mailing address

405 ASPEN LEAF DR
PONTE VEDRA FL
32081-6040
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-5577
  • Fax:
Mailing address:
  • Phone: 904-718-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4809
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: