Provider Demographics
NPI:1871707844
Name:LARRY L GRIFFITH MD PC
Entity type:Organization
Organization Name:LARRY L GRIFFITH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-561-7140
Mailing Address - Street 1:18700 N 64TH DR STE 108
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7110
Mailing Address - Country:US
Mailing Address - Phone:623-561-7140
Mailing Address - Fax:623-561-8343
Practice Address - Street 1:18700 N 64TH DR STE 108
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7110
Practice Address - Country:US
Practice Address - Phone:623-561-7140
Practice Address - Fax:623-561-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5334207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ23446Medicare ID - Type UnspecifiedGROUP #