Provider Demographics
NPI:1114971322
Name:HARTER, JOAN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:HARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:GORI HARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5125 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5624
Mailing Address - Country:US
Mailing Address - Phone:530-872-2000
Mailing Address - Fax:
Practice Address - Street 1:2809 OLIVE HIGHWAY
Practice Address - Street 2:SUITE #320
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966
Practice Address - Country:US
Practice Address - Phone:530-532-8687
Practice Address - Fax:530-538-3240
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59177OtherBLUE CROSS OF CA
00G591770OtherBLUE SHIELD OF CA
G59177OtherBLUE CROSS OF CA