Healthcare Provider Details

I. General information

NPI: 1215315536
Provider Name (Legal Business Name): RICKIE GRIFFITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

IV. Provider business mailing address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8000
  • Fax:
Mailing address:
  • Phone: 319-272-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5101021630
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101021630
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: