Provider Demographics
NPI:1417043837
Name:MUSGRAVE, ADAM RICHARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:RICHARD
Last Name:MUSGRAVE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3362 W INA RD
Mailing Address - Street 2:150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741
Mailing Address - Country:US
Mailing Address - Phone:520-900-7020
Mailing Address - Fax:888-972-1912
Practice Address - Street 1:1040 S HARRISON RD STE 120
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6601
Practice Address - Country:US
Practice Address - Phone:520-777-7025
Practice Address - Fax:888-972-1912
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPAL2326363AM0700X
AZ6804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ73878Medicare UPIN
TX531763YL36Medicare PIN
COC806926Medicare PIN
COP00373352Medicare PIN