Provider Demographics
NPI:1275567778
Name:HARPER, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:HARPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E 28TH ST
Mailing Address - Street 2:SMILEY'S CLINIC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1394
Mailing Address - Country:US
Mailing Address - Phone:612-333-0770
Mailing Address - Fax:612-333-0475
Practice Address - Street 1:2020 E 28TH ST
Practice Address - Street 2:SMILEY'S CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1394
Practice Address - Country:US
Practice Address - Phone:612-333-0770
Practice Address - Fax:612-333-0475
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN508577200Medicaid
MN2299000OtherARAZ
MN01-19272OtherMEDICA CHOICE & PRIMARY
MNHP10560OtherHEALTHPARTNERS
MN1018823OtherPREFERRED ONE
MN102637OtherUCARE
MN01-19272OtherMEDICA CHOICE & PRIMARY