Healthcare Provider Details

I. General information

NPI: 1790998789
Provider Name (Legal Business Name): DAVID C GRIFFIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 S COTTONWOOD ST SUITE 600
MURRAY UT
84107-6767
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3600
  • Fax: 801-507-3625
Mailing address:
  • Phone:
  • Fax: 801-507-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6359024-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number6359024-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: