Provider Demographics
NPI:1225071954
Name:MOREHEAD, DANIEL BLAKE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BLAKE
Last Name:MOREHEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2025
Mailing Address - Country:US
Mailing Address - Phone:512-535-3694
Mailing Address - Fax:512-535-4080
Practice Address - Street 1:708 W 10TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2025
Practice Address - Country:US
Practice Address - Phone:512-535-3694
Practice Address - Fax:512-535-4080
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL24822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH16995Medicare UPIN
TX8718M1Medicare ID - Type Unspecified