Organization
JACK W. GRIFFITH, III, D.O.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK WALTER GRIFFITH III D.O. (OWNER)
(909) 948-8888
Entity
Organization
Contact information
Practice address
7365 CARNELIAN STREET, SUITE 137, RANCHO CUCAMONGA, CA 91730-1100
(909) 948-8888
(909) 948-8839
Mailing address
7365 CARNELIAN STREET, SUITE 137, RANCHO CUCAMONGA, CA 91730-1100
(909) 948-8888
(909) 948-8839
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20A9405
CA
207ND0101X
MOHS-Micrographic Surgery Physician
20A9405
CA
207ND0900X
Dermatopathology Physician
20A9405
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
20A9405
CA
207NP0225X
Pediatric Dermatology Physician
20A9405
CA
207NS0135X
Procedural Dermatology Physician
20A9405
CA
Other
Enumeration date
11/02/2010
Last updated
05/28/2014
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