Organization
JACK W. GRIFFITH, III, D.O.
Active
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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