MEDICARE: DR. JEFFREY IRVIN MUSGROVE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4827	OH
2	103TC0700X	Clinical Psychologist	PY 7278	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598791410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY IRVIN MUSGROVE PSY.D.

Provider Business Mailing Address
First Line	:	534 NE 13TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1112
Country	:	US
Telephone Number	:	954-828-9077
Fax Number	:	954-828-9077

Provider Business Practice Location Address
First Line	:	534NE 13TH COURT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3607
Country	:	US
Telephone Number	:	954-828-9077
Fax Number	:	954-828-9077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	09/18/2008

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