Provider Demographics
NPI:1548234057
Name:HARPER, LARRY L (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:L
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 1:2452 MAHAN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5377
Mailing Address - Country:US
Mailing Address - Phone:850-671-0909
Mailing Address - Fax:850-878-5190
Practice Address - Street 1:2452 MAHAN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5377
Practice Address - Country:US
Practice Address - Phone:850-877-2126
Practice Address - Fax:850-878-5190
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74865208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42973OtherBLUE CROSS BLUE SHIELD FL
FL42973OtherBC/BS OF FLORIDA
GA00880019AMedicaid
FL254290100Medicaid
240007106Medicare PIN
FL42973OtherBLUE CROSS BLUE SHIELD FL
FL254290100Medicaid