MEDICARE: DR. PHILIP ALLEN HEAD JR. 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	207R00000X	Internal Medicine Physician	J5097	TX
2	2083X0100X	Occupational Medicine Physician	J5097	TX

General Provider Information

NPI Number	:	1710132766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ALLEN HEAD JR. M.D.

Provider Business Mailing Address
First Line	:	4804 N NAVARRO ST
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2079
Country	:	US
Telephone Number	:	713-715-8162
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 NARCISSUS RD
Second Line	:
City	:	CLEAR LAKE SHORES
State	:	TX
Zip	:	77565-2438
Country	:	US
Telephone Number	:	713-715-8162
Fax Number	:	866-265-4844

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

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	08/13/2020

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