Basic Information
| Provider Information | |||||||||
| NPI: | 1568726529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193848197 | ||||||||
| FaxNumber: | 3193562999 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193848197 | ||||||||
| FaxNumber: | 3193562999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2012 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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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 | 207R00000X | 56561 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD-46392 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | DR.0058309 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RN0300X | MD-46392 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | ENROLLED | 05 | MN | MEDICAID | 9000154806 | 05 | CO | MEDICAID | ENROLLED | 05 | IA | MEDICAID | 028588 | 01 | CO | KAISER COMMERCIAL NUMBER | OTHER | P01234119 | 01 | MN | RAILROAD MEDICARE | OTHER |