Basic Information
| Provider Information | |||||||||
| NPI: | 1134106909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 3037616278 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 3037616278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 26108 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 25034 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-22019 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 10025709000 | 05 | NE | MEDICAID | 1134106909/7726680 | 05 | SD | MEDICAID | 200254550A | 01 | KS | KS MEDICAID | OTHER | P00720353 | 01 | NE | RRMCR NE | OTHER | XPY201226 | 01 | CA | CA MEDICAID | OTHER | 01261080 | 05 | CO | MEDICAID | 84-059792913 | 05 | NE | MEDICAID | 104686178 | 01 | MI | MI MEDICAID | OTHER | 1134106909 | 05 | UT | MEDICAID | 053219401 | 01 | TX | TX MEDICAID | OTHER | 200025490A | 01 | OK | OK MEDICAID | OTHER | 300048001 | 01 | CO | RR MCRE RIA | OTHER | 864805 | 05 | AZ | MEDICAID | 300090003 | 01 | CO | RR MCRE DIA | OTHER | 02558496 | 01 | NY | NY MEDICAID | OTHER | 1134106909 | 01 | MT | MT MEDICAID | OTHER | 1134106909 | 05 | WY | MEDICAID | 300090004 | 01 | CO | RR MCRE MIC | OTHER | 15583783 | 01 | NM | NM MEDICAID | OTHER |