Griffith, Jack W

Griffith, Jack W is an sole proprietor health care provider with primary practice located at 7365 Carnelian St Suite 137, Rancho Cucamonga CA 91730-1158. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Griffith, Jack W can be contacted via phone (909) 948-8888.

Contact Information

Primary practice address
7365 Carnelian St Suite 137 Rancho Cucamonga CA 91730-1158
Phone: (909) 948-8888
Fax: (909) 948-8839
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 20A9405 California
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 20A9405 California
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 20A9405 California
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 20A9405 California

Profile Details

NPI number 1407884315
LBN Legal business name Griffith, Jack W
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 29th, 2006
Last updated Nov 7th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407884315 NPPES
California MEDICAID 00AX94050

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