Provider Demographics
NPI:1144454430
Name:GRIFFIN, DAVID L JR
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:GRIFFIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 STREAMVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6407
Mailing Address - Country:US
Mailing Address - Phone:407-718-4836
Mailing Address - Fax:
Practice Address - Street 1:336 STREAMVIEW WAY
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6407
Practice Address - Country:US
Practice Address - Phone:407-718-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG615172731900172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker