Individual
KEAN D GRIFFITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3098 OAK GROVE RD, POPLAR BLUFF, MO 63901-8938
(573) 776-9911
(573) 776-9913
Mailing address
3098 OAK GROVE RD, POPLAR BLUFF, MO 63901-8938
(573) 776-9911
(573) 776-9913
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2002008821
MO
2086X0206X
Surgical Oncology Physician
2002008821
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020051831
TRAVELERS MEDICARE
—
05
—
146373001
—
AR
05
—
203346812
—
MO
Enumeration date
01/11/2006
Last updated
09/01/2020
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