Provider Demographics
NPI:1922176882
Name:MUSGRAVE, DAVID DEWEY (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DEWEY
Last Name:MUSGRAVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 OFFICE PARK RD
Mailing Address - Street 2:SUITE 328
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2587
Mailing Address - Country:US
Mailing Address - Phone:515-457-7124
Mailing Address - Fax:
Practice Address - Street 1:1001 OFFICE PARK RD
Practice Address - Street 2:SUITE 328
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2587
Practice Address - Country:US
Practice Address - Phone:515-457-7124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01531204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0097212Medicaid
IAD46463Medicare UPIN
IA0097212Medicaid