MEDICARE: MICHAEL TODD GRIFFIN PA

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	207Y00000X	Otolaryngology Physician	LA10629	LA
2	363A00000X	Physician Assistant	PA.A10629	LA

General Provider Information

NPI Number	:	1710985049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TODD GRIFFIN PA

Provider Business Mailing Address
First Line	:	604 N ACADIA RD STE 101
Second Line	:
City	:	THIBODAUX
State	:	LA
Zip	:	70301-4897
Country	:	US
Telephone Number	:	985-446-5079
Fax Number	:	985-447-2497

Provider Business Practice Location Address
First Line	:	100 PHOENIX DR
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-2396
Country	:	US
Telephone Number	:	337-898-3700
Fax Number	:	337-898-3702

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	11/13/2024

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Directions to “ MICHAEL TODD GRIFFIN PA” Practice Location

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