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NPI Code Detail

MEDICARE: WILLIAM JOHN GRIFFITH

MEDICARE: WILLIAM JOHN GRIFFITH
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
1363A00000XPhysician Assistant2814NE

General Provider Information

NPI Number : 1518578574
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM JOHN GRIFFITH
Provider Business Mailing Address
First Line : 248 BURNHAM DR
Second Line :
City : ALLIANCE
State : NE
Zip : 69301-2120
Country : US
Telephone Number : 480-620-0524
Fax Number :
Provider Business Practice Location Address
First Line : 2101 BOX BUTTE AVE
Second Line :
City : ALLIANCE
State : NE
Zip : 69301-4444
Country : US
Telephone Number : 308-762-6660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2020
Last Update Date : 10/03/2022

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