Provider Demographics
NPI:1346440583
Name:HARPER, THOMAS WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WAYNE
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 1:3810 SPRINGHURST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6100
Mailing Address - Country:US
Mailing Address - Phone:502-897-9881
Mailing Address - Fax:502-897-9824
Practice Address - Street 1:3810 SPRINGHURST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6100
Practice Address - Country:US
Practice Address - Phone:502-897-9881
Practice Address - Fax:502-897-9824
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42847207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100093050Medicaid
KY42847OtherKENTUCKY LICENSE NUMBER
KY42847OtherKENTUCKY LICENSE NUMBER