Healthcare Provider Details

I. General information

NPI: 1770710261
Provider Name (Legal Business Name): DAVID LAWRENCE GRIFFIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N STE 360
ALLEN TX
75013-6111
US

IV. Provider business mailing address

1650 REPUBLIC PKWY STE 150
MESQUITE TX
75150-6917
US

V. Phone/Fax

Practice location:
  • Phone: 214-691-1902
  • Fax: 214-987-1845
Mailing address:
  • Phone: 214-692-8262
  • Fax: 214-853-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberS0163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: