Provider Demographics
NPI:1720169386
Name:MOREHEAD, GLEN P (MD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:P
Last Name:MOREHEAD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:51753 EL DORADO DR
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-9034
Mailing Address - Country:US
Mailing Address - Phone:760-619-2309
Mailing Address - Fax:866-428-0708
Practice Address - Street 1:1180 N. INDIAN CANYON DR.
Practice Address - Street 2:E218
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-416-4800
Practice Address - Fax:770-229-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2021-01-22
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Provider Licenses
StateLicense IDTaxonomies
GA31076207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000447433AMedicaid
GA000447433CMedicaid