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Individual

CARL D GRIFFIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
(765) 448-8702
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01030600A
IN
2083X0100X
Occupational Medicine Physician
Primary
01030600A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000197993
ANTHEM PROVIDER NUMBER
IN
05
100085950
IN
01
10825175
CAQH NUMBER
IN
01
9397093
PHCS PID NUMBER
IN
05
GR15376011
IN
Enumeration date
03/15/2006
Last updated
07/23/2012
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