MEDICARE: DARRELL L GRIFFIN 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	207N00000X	Dermatology Physician	AG1675478	MO

General Provider Information

NPI Number	:	1558321554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL L GRIFFIN M.D.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9016
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	1223 MAPLE ST
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-7616
Country	:	US
Telephone Number	:	573-760-8811
Fax Number	:	573-760-8844

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	10/06/2023

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