MEDICARE: DR. DANIEL T GRIFFITH 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	207K00000X	Allergy & Immunology Physician	ME87491	FL
2	207R00000X	Internal Medicine Physician	ME87491	FL
3	207RA0401X	Addiction Medicine (Internal Medicine) Physician	ME87491	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BW547A	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1750339032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL T GRIFFITH M.D.

Provider Business Mailing Address
First Line	:	2214 E HENRY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610
Country	:	US
Telephone Number	:	813-710-5001
Fax Number	:	813-710-5001

Provider Business Practice Location Address
First Line	:	2701 W BUSCH BLVD STE 144
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4578
Country	:	US
Telephone Number	:	813-452-5000
Fax Number	:	813-710-5001

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/27/2020

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