MEDICARE: DR. EUGENE RAWSON GRIFFIN III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	ME45932	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160053365	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1124024310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE RAWSON GRIFFIN III MD

Provider Business Mailing Address
First Line	:	PO BOX 17577
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-7577
Country	:	US
Telephone Number	:	904-399-1623
Fax Number	:	904-399-1624

Provider Business Practice Location Address
First Line	:	3627 UNIVERSITY BLVD S
Second Line	:	STE 615
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-7401
Country	:	US
Telephone Number	:	904-399-1623
Fax Number	:	904-399-1624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/14/2016

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