Provider Demographics
NPI:1144342981
Name:HEAD, JERALD L (MD)
Entity type:Individual
Prefix:
First Name:JERALD
Middle Name:L
Last Name:HEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:302 UNIVERSITY BLVD
Mailing Address - Street 2:CLINIC ADMINISTRATION
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1032
Mailing Address - Country:US
Mailing Address - Phone:512-509-3926
Mailing Address - Fax:
Practice Address - Street 1:325 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 335
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665
Practice Address - Country:US
Practice Address - Phone:512-509-3926
Practice Address - Fax:512-509-3925
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2010-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH7064208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice