MEDICARE: DOUGLAS GRIFFIN DPM

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	213E00000X	Podiatrist	POD-000516	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480032589	OTHER	AZ	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AZ0194950	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1215923750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS GRIFFIN DPM

Provider Business Mailing Address
First Line	:	6116 E. ARBOR AVE
Second Line	:	SUITE 118
City	:	MESA
State	:	AZ
Zip	:	85206-5235
Country	:	US
Telephone Number	:	480-924-1552
Fax Number	:	480-830-8417

Provider Business Practice Location Address
First Line	:	6116 E. ARBOR AVE
Second Line	:	SUITE 118
City	:	MESA
State	:	AZ
Zip	:	85206-5235
Country	:	US
Telephone Number	:	480-924-1552
Fax Number	:	480-830-8417

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	10/12/2022

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Directions to “ DOUGLAS GRIFFIN DPM” Practice Location

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