Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | F6974 | TX |
NPI | 1487772612 |
---|---|
Provider Name | Dr. John Mark Morehead |
First Address | San Antonio, TX 78291-0087 |
Second Address | San Antonio, TX 78207-3110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 19/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102903504 | (05) | TX |