Provider Demographics
NPI:1457318529
Name:HARPER, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
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 1:231 S NEVADA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4233
Mailing Address - Country:US
Mailing Address - Phone:970-249-3800
Mailing Address - Fax:970-249-3838
Practice Address - Street 1:231 S NEVADA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4233
Practice Address - Country:US
Practice Address - Phone:970-249-3800
Practice Address - Fax:970-249-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0046000207Y00000X
VA0101038731207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010255562Medicaid
VA386662OtherANTHEM BCBS
VA211159OtherSOUTHERN HEALTH
VA003379A91Medicare ID - Type Unspecified