Healthcare Provider Details

I. General information

NPI: 1770565715
Provider Name (Legal Business Name): JOHN GRIFFITHS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S 90TH ST
OMAHA NE
68114-3963
US

IV. Provider business mailing address

4353 DODGE ST
OMAHA NE
68131-2709
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2020
  • Fax:
Mailing address:
  • Phone: 402-552-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11025
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: