Healthcare Provider Details

I. General information

NPI: 1295908879
Provider Name (Legal Business Name): ELIZABETH RUSSELL GRIFFIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 S FORD RD STE 300
ZIONSVILLE IN
46077-2045
US

IV. Provider business mailing address

262 S FORD RD STE 300
ZIONSVILLE IN
46077-2045
US

V. Phone/Fax

Practice location:
  • Phone: 317-204-3695
  • Fax: 812-328-8041
Mailing address:
  • Phone: 317-204-3695
  • Fax: 812-328-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101265547
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2011-0126
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01094885A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: