Healthcare Provider Details

I. General information

NPI: 1235525700
Provider Name (Legal Business Name): DEREK NATHANIEL MUSGROVE MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2015
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 QUEEN ST
SASKATOON SASKATCHEWAN
S7K 0M7
CA

IV. Provider business mailing address

2041 GEORGIA AVE NW HOWARD UNIVERISTY HOSPITAL
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 306-222-5974
  • Fax:
Mailing address:
  • Phone: 202-855-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number12242
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: