Provider Demographics
NPI: | 1114911427 |
---|---|
Name: | HARPER, WILLIAM R JR (PA-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | WILLIAM |
Middle Name: | R |
Last Name: | HARPER |
Suffix: | JR |
Gender: | M |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 10150 HIGHLAND MANOR DR STE 205 |
Mailing Address - Street 2: | |
Mailing Address - City: | TAMPA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33610-9727 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 813-259-1013 |
Mailing Address - Fax: | 813-254-0396 |
Practice Address - Street 1: | 10150 HIGHLAND MANOR DR STE 205 |
Practice Address - Street 2: | |
Practice Address - City: | TAMPA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33610-9727 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-259-1013 |
Practice Address - Fax: | 813-254-0396 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-09-01 |
Last Update Date: | 2023-12-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PA2167 | 363AM0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | Y00Z3 | Other | BC/BS FLA |
FL | 290336900 | Medicaid | |
E1044 | Medicare ID - Type Unspecified | ||
FL | 290336900 | Medicaid | |
FL | E1004Y | Medicare PIN |