Basic Information
| Provider Information | |||||||||
| NPI: | 1255445664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORHEAD | ||||||||
| FirstName: | FRANCIS | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41201 SCHADDEN RD | ||||||||
| Address2: | |||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440352249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403240451 | ||||||||
| FaxNumber: | 4403240441 | ||||||||
| Practice Location | |||||||||
| Address1: | 41201 SCHADDEN RD | ||||||||
| Address2: | |||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440352249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403240451 | ||||||||
| FaxNumber: | 4403240441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | A23670 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 35.142657 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | A23670 | 01 | CA | BLUE CROSS | OTHER | 00A236700 | 05 | CA | MEDICAID | ZZZ09450Z | 01 | CA | BLUE SHIELD | OTHER |