Basic Information
Provider Information | |||||||||
NPI: | 1003011370 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GRIFFITHS | ||||||||
FirstName: | PAMELA | ||||||||
MiddleName: | SUE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HILVERS | ||||||||
OtherFirstName: | PAMELA | ||||||||
OtherMiddleName: | SUE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3200 E CAMELBACK RD STE 250 | ||||||||
Address2: |   | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850182327 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6029331814 | ||||||||
FaxNumber: | 6029338972 | ||||||||
Practice Location | |||||||||
Address1: | 3555 S VAL VISTA DR | ||||||||
Address2: |   | ||||||||
City: | GILBERT | ||||||||
State: | AZ | ||||||||
PostalCode: | 852977323 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6029336345 | ||||||||
FaxNumber: | 6029338975 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/18/2007 | ||||||||
LastUpdateDate: | 12/10/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/17/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 22886 | WV | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 2080N0001X | P1326 | TX | N |   | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 2080N0001X | 50068 | AZ | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
ID | Type | State | Issuer | Description | P1326 | 01 | TX | STATE MEDICAL BOARD | OTHER | 50068 | 01 | AZ | ARIZONA STATE LICENSE | OTHER | 22886 | 01 | WV | WV BOARD OF MEDICINE | OTHER |