Healthcare Provider Details

I. General information

NPI: 1275533143
Provider Name (Legal Business Name): JOHN W MUSGRAVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7024 NORDIC DR
CEDAR FALLS IA
50613-6309
US

IV. Provider business mailing address

7024 NORDIC DR
CEDAR FALLS IA
50613-6309
US

V. Phone/Fax

Practice location:
  • Phone: 319-266-3127
  • Fax: 319-266-5756
Mailing address:
  • Phone: 319-266-3127
  • Fax: 319-266-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25603
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: