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JACK W. GRIFFITH III D.O. NPI 1104126457


NPI Information

NPI: 1104126457
Provider Name: JACK W. GRIFFITH, III, D.O.
Classification: Dermatology - 207N00000X
Entity Type: Organization
Address:
7365 CARNELIAN STREET
SUITE 137
RANCHO CUCAMONGA, CA
ZIP 91730
Phone: (909) 948-8888
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JACK W. GRIFFITH, III, D.O. is a dermatology in Rancho Cucamonga, CA. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. JACK W. GRIFFITH, III, D.O. NPI is 1104126457. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

7365 CARNELIAN STREET
SUITE 137
RANCHO CUCAMONGA, CA
ZIP 91730-100
Phone: (909) 948-8888
Fax: (909) 948-8839

The provider's authorized official is Jack Walter Griffith .
The authorized official title is Owner and has the following contact phone number (909) 948-8888.

The enumeration date for this NPI number is 11/2/2010 and was last updated on 5/28/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207ND0101XDermatologyMOHS-Micrographic Surgery20A9405CALIFORNIANo
2207ND0900XDermatologyDermatopathology20A9405CALIFORNIANo
3207NI0002XDermatologyClinical & Laboratory Dermatological Immunology20A9405CALIFORNIANo
4207NP0225XDermatologyPediatric Dermatology20A9405CALIFORNIANo
5207NS0135XDermatologyProcedural Dermatology20A9405CALIFORNIANo
6207N00000XDermatology20A9405CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1020A94050MEDICARE PINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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