Healthcare Provider Details

I. General information

NPI: 1962004804
Provider Name (Legal Business Name): GLEN P MOREHEAD MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE E218
PALM SPRINGS CA
92262-4885
US

IV. Provider business mailing address

51753 EL DORADO DR
LA QUINTA CA
92253-9034
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4800
  • Fax:
Mailing address:
  • Phone: 760-619-2309
  • Fax: 866-428-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: GLEN P MOREHEAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-619-2309