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Individual

DR. JACK W GRIFFITH III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
7365 CARNELIAN ST, SUITE 137, RANCHO CUCAMONGA, CA 91730-1158
(909) 948-8888
(909) 948-8839
Mailing address
7365 CARNELIAN ST, SUITE 137, RANCHO CUCAMONGA, CA 91730-1158
(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
207P00000X
Emergency Medicine Physician
20A9405
CA
207R00000X
Internal Medicine Physician
20A9405
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00AX94050
CA
Enumeration date
06/29/2006
Last updated
11/07/2014
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