Healthcare Provider Details

I. General information

NPI: 1457500704
Provider Name (Legal Business Name): MATTHEW PATRICK GRIFFIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MEDICAL PARK DR
MEXICO MO
65265-3724
US

IV. Provider business mailing address

116 S EUCLID AVE STE 1
WESTFIELD NJ
07090-2187
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-8500
  • Fax: 573-581-5397
Mailing address:
  • Phone: 312-509-3930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09729800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP01545
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: