MEDICARE: VIRGINIA ROSS GRIFFIN PA-C

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	363A00000X	Physician Assistant	2638	AZ

General Provider Information

NPI Number	:	1255437497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA ROSS GRIFFIN PA-C

Provider Business Mailing Address
First Line	:	19401 N CAVE CREEK RD
Second Line	:	#18
City	:	PHOENIX
State	:	AZ
Zip	:	85024-1801
Country	:	US
Telephone Number	:	602-996-0099
Fax Number	:

Provider Business Practice Location Address
First Line	:	19401 N CAVE CREEK RD
Second Line	:	#18
City	:	PHOENIX
State	:	AZ
Zip	:	85024-1801
Country	:	US
Telephone Number	:	602-996-0099
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	12/19/2014

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