MEDICARE: MARK GRIFFO M.D.

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	207VG0400X	Gynecology Physician	91736	FL

General Provider Information

NPI Number	:	1285664250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK GRIFFO M.D.

Provider Business Mailing Address
First Line	:	2506 SAND MINE RD
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33897-3402
Country	:	US
Telephone Number	:	863-424-4321
Fax Number	:	863-424-3007

Provider Business Practice Location Address
First Line	:	2506 SAND MINE RD
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33897-3402
Country	:	US
Telephone Number	:	863-424-4321
Fax Number	:	863-424-3007

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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Directions to “ MARK GRIFFO M.D.” Practice Location

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