Provider Demographics
NPI:1790787703
Name:MOREHEAD, HARRY STANLEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:STANLEY
Last Name:MOREHEAD
Suffix:JR
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 1:1780 E FLORENCE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4782
Mailing Address - Country:US
Mailing Address - Phone:520-381-6738
Mailing Address - Fax:520-381-6070
Practice Address - Street 1:1780 E FLORENCE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4782
Practice Address - Country:US
Practice Address - Phone:520-381-6738
Practice Address - Fax:520-381-6070
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ321782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ96971Medicare UPIN