Basic Information
| Provider Information | |||||||||
| NPI: | 1679669154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUSGROVE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | LARKIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2407 HELTON DR | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356301067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567185900 | ||||||||
| FaxNumber: | 2567185918 | ||||||||
| Practice Location | |||||||||
| Address1: | 2407 HELTON DR | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356301067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567185900 | ||||||||
| FaxNumber: | 2567185918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 01/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 8101 | AL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 51017712 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 000017712 | 05 | AL | MEDICAID |