Healthcare Provider Details

I. General information

NPI: 1518977461
Provider Name (Legal Business Name): PAUL GRIFFITHS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 THORPE RD
LAS CRUCES NM
88012-9776
US

IV. Provider business mailing address

PO BOX 370
HATCH NM
87937
US

V. Phone/Fax

Practice location:
  • Phone: 575-382-9292
  • Fax: 575-267-1747
Mailing address:
  • Phone: 575-267-3280
  • Fax: 575-267-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2003-0038
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: