MEDICARE: CARL N. GRIFFIN D.O.

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	207Q00000X	Family Medicine Physician	03095	OK
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	3095	OK

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
2	73-0804209	OTHER	OK	TAX ID
3	730804209001	OTHER	OK	BC GROUP NUMBER

General Provider Information

NPI Number	:	1548365117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL N. GRIFFIN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 269064
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9064
Country	:	US
Telephone Number	:	405-231-3857
Fax Number	:	405-272-7977

Provider Business Practice Location Address
First Line	:	6908 E RENO AVE
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-2128
Country	:	US
Telephone Number	:	405-737-7000
Fax Number	:	405-737-7700

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	10/20/2014

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Directions to “ CARL N. GRIFFIN D.O.” Practice Location

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