Provider Demographics
NPI:1275533143
Name:MUSGRAVE, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MUSGRAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7024 NORDIC DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6309
Mailing Address - Country:US
Mailing Address - Phone:319-266-3127
Mailing Address - Fax:319-266-5756
Practice Address - Street 1:7024 NORDIC DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6309
Practice Address - Country:US
Practice Address - Phone:319-266-3127
Practice Address - Fax:319-266-5756
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA25603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1031351Medicaid
IA1031351Medicaid
A03073Medicare UPIN