Provider Demographics
NPI:1598791410
Name:MUSGROVE, JEFFREY IRVIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:IRVIN
Last Name:MUSGROVE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 NE 13TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1112
Mailing Address - Country:US
Mailing Address - Phone:954-828-9077
Mailing Address - Fax:954-828-9077
Practice Address - Street 1:534NE 13TH COURT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3607
Practice Address - Country:US
Practice Address - Phone:954-828-9077
Practice Address - Fax:954-828-9077
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4827103TC0700X
FLPY 7278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2069096Medicaid
OH2069096Medicaid