Healthcare Provider Details

I. General information

NPI: 1659377992
Provider Name (Legal Business Name): FRANK ALLEN MOORHEAD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: F. ALLEN MOORHEAD JR. M.D.

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 MAIN ST
NEODESHA KS
66757-1634
US

IV. Provider business mailing address

709 MAIN ST PO BOX 180
NEODESHA KS
66757-1634
US

V. Phone/Fax

Practice location:
  • Phone: 620-325-2200
  • Fax: 620-325-2410
Mailing address:
  • Phone: 620-325-2200
  • Fax: 620-325-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-13549
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: