Individual
DR. MARLEY A GRIFFIN FAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
138 N DIXON RD, KOKOMO, IN 46901
(765) 236-8282
Mailing address
138 N DIXON RD, KOKOMO, IN 46901-4154
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02004405A
IN
207R00000X
Internal Medicine Physician
5101019418
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201232310
—
IN
Enumeration date
06/26/2011
Last updated
06/24/2022
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