=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215093273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EARL E GRIFFITH PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 SW 6TH ST
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-283-4437
-----------------------------------------------------
Fax | 772-288-1180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 SW 6TH ST
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-283-4437
-----------------------------------------------------
Fax | 772-288-1180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY0003020
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------