Provider Demographics
NPI:1659377992
Name:MOORHEAD, FRANK ALLEN JR (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:ALLEN
Last Name:MOORHEAD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:F.
Other - Middle Name:ALLEN
Other - Last Name:MOORHEAD
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:709 MAIN ST
Mailing Address - Street 2:PO BOX 180
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1634
Mailing Address - Country:US
Mailing Address - Phone:620-325-2200
Mailing Address - Fax:620-325-2410
Practice Address - Street 1:709 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1634
Practice Address - Country:US
Practice Address - Phone:620-325-2200
Practice Address - Fax:620-325-2410
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3200470OtherSIGNA HEALTH INS
KS990009838OtherRR MEDICARE/PALMETTO
KS30004284360001Medicaid
KS3120OtherPREFERRED HEALTH SYSTEMS
KS10008169AMedicaid
KS611050OtherFIRST GUARD
KS3120OtherPREFERRED HEALTH SYSTEMS
KS611050OtherFIRST GUARD
KS10008169AMedicaid