MEDICARE: GRIFFIN MICHAEL ELBERT DO

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	207QS0010X	Sports Medicine (Family Medicine) Physician	20A19673	CA
2	207Q00000X	Family Medicine Physician	20A19673	CA

General Provider Information

NPI Number	:	1124682745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRIFFIN MICHAEL ELBERT DO

Provider Business Mailing Address
First Line	:	1320 MARICOPA HWY STE D
Second Line	:
City	:	OJAI
State	:	CA
Zip	:	93023-3154
Country	:	US
Telephone Number	:	805-948-6730
Fax Number	:	805-948-6731

Provider Business Practice Location Address
First Line	:	1320 MARICOPA HWY STE D
Second Line	:
City	:	OJAI
State	:	CA
Zip	:	93023-3154
Country	:	US
Telephone Number	:	805-948-6730
Fax Number	:	805-948-6731

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

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	06/09/2026

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