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NPI Code Detail

MEDICARE: WALTER G GRIFFITH JR. M.D.

MEDICARE: WALTER G GRIFFITH JR. 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
12084P0800XPsychiatry PhysicianME61913FL

General Provider Information

NPI Number : 1780792374
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER G GRIFFITH JR. M.D.
Provider Business Mailing Address
First Line : PO BOX 55156
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33732-5156
Country : US
Telephone Number : 727-577-1203
Fax Number : 727-577-0983
Provider Business Practice Location Address
First Line : 5565 DR MARTIN LUTHER KING JR ST N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33703-1203
Country : US
Telephone Number : 727-577-1203
Fax Number : 727-577-0983
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/08/2007

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