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NPI Code Detail

MEDICARE: DR. WALTER DOUGLAS MOORHEAD M.D.

MEDICARE: DR. WALTER DOUGLAS 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
12084P0800XPsychiatry PhysicianC35623CA

General Provider Information

NPI Number : 1447282777
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WALTER DOUGLAS MOORHEAD M.D.
Provider Business Mailing Address
First Line : 2180 MILVIA ST
Second Line : 2RD. FLOOR MH
City : BERKELEY
State : CA
Zip : 94704-1169
Country : US
Telephone Number : 510-981-5221
Fax Number : 510-981-5235
Provider Business Practice Location Address
First Line : 2640 MARTIN LUTHER KING JR WAY
Second Line :
City : BERKELEY
State : CA
Zip : 94704-3238
Country : US
Telephone Number : 510-981-5290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 07/06/2012

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