Provider Demographics
NPI:1548770811
Name:MUSGRAVES, JOHN L
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:MUSGRAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 PHILCO
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-5176
Mailing Address - Country:US
Mailing Address - Phone:870-278-6002
Mailing Address - Fax:870-284-2998
Practice Address - Street 1:3404 PHILCO
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-5176
Practice Address - Country:US
Practice Address - Phone:870-278-6002
Practice Address - Fax:870-284-2998
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver