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General NPI Number Information
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NPI Number | 1134589559
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Entity Type | Individual
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Provider Name | FREDERICK P GRIFFITH IV MD
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Gender | Male
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 4700 LAS VEGAS BLVD N
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City | NELLIS AFB
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State | NV
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Zip | 89191-6600
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Country | US
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Telephone | 702-653-2344
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Fax |
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Provider Business Mailing Address
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Address Line | 10268 GAETA PL
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City | LAS VEGAS
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State | NV
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Zip | 89134-2603
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Country | US
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Telephone | 603-493-8982
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101263351
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20467
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License Number State | NV
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