MEDICARE: GARY E GRIFFIN DO

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	207Q00000X	Family Medicine Physician	E1832	AR
2	207Q00000X	Family Medicine Physician	3822	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932195849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY E GRIFFIN DO

Provider Business Mailing Address
First Line	:	1122 NE 13TH ST
Second Line	:	ORI 236
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-1039
Country	:	US
Telephone Number	:	405-736-6811
Fax Number	:	405-736-6863

Provider Business Practice Location Address
First Line	:	1212 S DOUGLAS BLVD
Second Line	:	SUITE B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73130-5259
Country	:	US
Telephone Number	:	405-736-6811
Fax Number	:	405-736-6863

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	09/20/2012

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