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General NPI Number Information
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NPI Number | 1750008181
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Entity Type | Organization
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Legal Business Name | MUSGRAVE SPECIALIZED CARE, PLLC
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 3061 W SOUTHLAKE BLVD STE 130
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City | SOUTHLAKE
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State | TX
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Zip | 76092-0314
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Country | US
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Telephone | 214-668-0414
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Fax |
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Provider Business Mailing Address
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Address Line | 251 E SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6269
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DANA GASSAWAY
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Credential |
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Telephone | 214-668-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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