Provider Demographics
NPI:1710132766
Name:HEAD, PHILIP ALLEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALLEN
Last Name:HEAD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4804 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2079
Mailing Address - Country:US
Mailing Address - Phone:713-715-8162
Mailing Address - Fax:
Practice Address - Street 1:507 NARCISSUS RD
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE SHORES
Practice Address - State:TX
Practice Address - Zip Code:77565-2438
Practice Address - Country:US
Practice Address - Phone:713-715-8162
Practice Address - Fax:866-265-4844
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2020-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ5097207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF80203Medicare UPIN
TXTXB142280Medicare Oscar/Certification