Basic Information
| Provider Information | |||||||||
| NPI: | 1609836824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACKMON | ||||||||
| FirstName: | GRIFFITH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 CHERRY AVE | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983104229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607445804 | ||||||||
| FaxNumber: | 2069654279 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 CHERRY AVE | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983104229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607445804 | ||||||||
| FaxNumber: | 2069654279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | MD00029049 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207LC0200X | MD00029049 | WA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207RS0012X | MD00029049 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | MD00029049 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1014390 | 05 | WA | MEDICAID | 1115468 | 05 | WA | MEDICAID |