Provider Demographics
NPI:1700856911
Name:GRIFFIN, DOUGLAS M (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31087207Q00000X
ND13899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01011082OtherPREFERRED ONE
MN0103802OtherMEDICA
MN595969OtherAMERICA'S PPO
MN114455D277OtherUCARE
MN53Q29GROtherBLUE SHIELD
MNHP21657OtherHEALTH PARTNERS
MN451595100Medicaid
MNA013OtherCHAMPUS
MNA013OtherCHAMPUS
MN451595100Medicaid