Provider Demographics
NPI:1427097781
Name:HEAD, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:HEAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:391B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-843-8222
Mailing Address - Fax:314-843-1662
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:391B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-843-8222
Practice Address - Fax:314-843-1662
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MORID662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO274050091Medicare ID - Type UnspecifiedSJH-MO
MO216050238Medicare ID - Type UnspecifiedSJHW-MO