SHANE MUSGROVE

MERIDIAN, ID
NPI1427408251
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA-1610)
Additional Taxonomies363A00000X Physician Assistant
(Licence: CO  4759)
Enumeration Date2016-06-13
Last Update Date2023-09-08
Business Address
SHANE MUSGROVE PA
3399 E LOUISE DR STE 400
MERIDIAN, ID 83642-5212
Phone number: 208-706-4650
Mailing Address
SHANE MUSGROVE PA
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number: 208-381-2222