Provider Demographics
NPI:1912913112
Name:SEGROVES, DAVID JAY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAY
Last Name:SEGROVES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:168 N CASEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-9415
Mailing Address - Country:US
Mailing Address - Phone:989-453-4495
Mailing Address - Fax:989-453-4450
Practice Address - Street 1:168 N CASEVILLE RD
Practice Address - Street 2:
Practice Address - City:PIGEON
Practice Address - State:MI
Practice Address - Zip Code:48755-9415
Practice Address - Country:US
Practice Address - Phone:989-453-4495
Practice Address - Fax:989-453-4450
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP02167Medicare UPIN
MI0N751190Medicare PIN