MEDICARE: STEPHEN GRIFFIN 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	363A00000X	Physician Assistant	PA04450	TX
2	363AS0400X	Surgical Physician Assistant	PA04450	TX

General Provider Information

NPI Number	:	1700885654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN GRIFFIN PA-C

Provider Business Mailing Address
First Line	:	11675 JOLLYVILLE RD
Second Line	:	STE 207
City	:	AUSTIN
State	:	TX
Zip	:	78759-4105
Country	:	US
Telephone Number	:	512-856-1000
Fax Number	:	512-856-4040

Provider Business Practice Location Address
First Line	:	11675 JOLLYVILLE RD
Second Line	:	STE 207
City	:	AUSTIN
State	:	TX
Zip	:	78759-4105
Country	:	US
Telephone Number	:	512-856-1000
Fax Number	:	512-856-4040

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	10/24/2022

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Directions to “ STEPHEN GRIFFIN PA-C” Practice Location

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