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NPI Code Detail

MEDICARE: ETHAN GRIFFIN

MEDICARE: ETHAN GRIFFIN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1265363709
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN GRIFFIN
Provider Business Mailing Address
First Line : 2817 ROCK MERRITT AVE
Second Line :
City : FORT BRAGG
State : NC
Zip : 28310-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2817 ROCK MERRITT AVE
Second Line :
City : FORT BRAGG
State : NC
Zip : 28310-0001
Country : US
Telephone Number : 910-643-2415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “ ETHAN GRIFFIN ” Practice Location

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