Provider Demographics
NPI:1548490212
Name:GRIFFIN, JOHN RANDALL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RANDALL
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:1001 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7407
Practice Address - Country:US
Practice Address - Phone:713-442-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0644207ND0900X, 207N00000X, 207ND0900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338357202Medicaid
TX338357203Medicaid
TX338357202Medicaid
TX359142YKTXMedicare PIN
TX338357202Medicaid
MN070000898Medicare PIN
TX359142YKTUMedicare PIN
TX359142ZHVCOtherMEDICARE PTAN
MNENROLLEDMedicaid
TX359142YKTUMedicare PIN