MEDICARE: DORA Y GRIFFITH 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	363AM0700X	Medical Physician Assistant	PA00361	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477569523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORA Y GRIFFITH PA-C

Provider Business Mailing Address
First Line	:	2768 PHARMACY RD
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6201
Country	:	US
Telephone Number	:	956-487-5621
Fax Number	:	956-487-5862

Provider Business Practice Location Address
First Line	:	2768 PHARMACY RD
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6201
Country	:	US
Telephone Number	:	956-487-5621
Fax Number	:	956-487-5862

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/30/2015

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Directions to “ DORA Y GRIFFITH PA-C” Practice Location

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