Provider Demographics
NPI:1114906476
Name:HARPER, GEORGE M (EDD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:HARPER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-1915
Mailing Address - Country:US
Mailing Address - Phone:319-334-6820
Mailing Address - Fax:319-334-7086
Practice Address - Street 1:515 2ND ST NE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-1915
Practice Address - Country:US
Practice Address - Phone:319-334-6820
Practice Address - Fax:319-334-7086
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00355103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13342OtherBLUE CROSS/BLUE SHIELD
IA13342Medicare ID - Type UnspecifiedMEDICARE