1861440844 NPI number — DR. JOHN MONTGOMERY GRIFFIN JR. PH.D.

Table of content: DR. JOHN MONTGOMERY GRIFFIN JR. PH.D. (NPI 1861440844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861440844 NPI number — DR. JOHN MONTGOMERY GRIFFIN JR. PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIN
Provider First Name:
JOHN
Provider Middle Name:
MONTGOMERY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861440844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16404 SMOKEY POINT BLVD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98223-8417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-651-0610
Provider Business Mailing Address Fax Number:
360-651-0656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16404 SMOKEY POINT BLVD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-8417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-651-0610
Provider Business Practice Location Address Fax Number:
360-651-0656
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1564 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 483531 . This is a "VALUE OPTIONS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0198265 . This is a "DEPT OFLABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 297445100000 . This is a "PREMARA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 417158 . This is a "DEPARTMENT OF DISABILITIE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2497GR . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7049695 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8913453 . This is a "CRIME VICTIMS COMPENSATIO" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005893652 . This is a "AETNA PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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