Basic Information
| Provider Information | |||||||||
| NPI: | 1962004804 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLEN P MOREHEAD MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51753 EL DORADO DR | ||||||||
| Address2: | |||||||||
| City: | LA QUINTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922539034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606192309 | ||||||||
| FaxNumber: | 8664280708 | ||||||||
| Practice Location | |||||||||
| Address1: | 1180 N INDIAN CANYON DR STE E218 | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922624885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604164800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2020 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | MOREHEAD | ||||||||
| AuthorizedOfficialFirstName: | GLEN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7606192309 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.