MEDICARE: LOUISE COPE MOORHEAD M.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	207W00000X	Ophthalmology Physician	F5437	TX

General Provider Information

NPI Number	:	1588655583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE COPE MOORHEAD M.D.

Provider Business Mailing Address
First Line	:	3816 NORTHWESTERN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 NORTHWESTERN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2048
Country	:	US
Telephone Number	:	713-481-2351
Fax Number	:

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/13/2007

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