MEDICARE: DR. WILLIAM S. GRIFFIS D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	30648	CO

General Provider Information

NPI Number	:	1821080953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM S. GRIFFIS D.O.

Provider Business Mailing Address
First Line	:	PO BOX 973403
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75397-3403
Country	:	US
Telephone Number	:	719-634-5340
Fax Number	:	719-634-5517

Provider Business Practice Location Address
First Line	:	2162 HOLLOW BROOK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1444
Country	:	US
Telephone Number	:	719-634-5340
Fax Number	:	719-634-5517

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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