Provider Demographics
NPI:1477599538
Name:HARPER, RICHARD T (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:HARPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 RIGBY LAKE DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5192
Mailing Address - Country:US
Mailing Address - Phone:208-745-5021
Mailing Address - Fax:208-745-5026
Practice Address - Street 1:711 RIGBY LAKE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5192
Practice Address - Country:US
Practice Address - Phone:208-745-5021
Practice Address - Fax:208-745-5026
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID0330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806913700Medicaid
ID806913700Medicaid
1302877Medicare ID - Type Unspecified