Provider Demographics
NPI:1851394803
Name:HARPER, SPENCE D (DPM)
Entity Type:Individual
Prefix:
First Name:SPENCE
Middle Name:D
Last Name:HARPER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032
Mailing Address - Country:US
Mailing Address - Phone:435-657-0329
Mailing Address - Fax:801-274-9064
Practice Address - Street 1:190 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032
Practice Address - Country:US
Practice Address - Phone:435-657-0329
Practice Address - Fax:801-274-9064
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1131960001332B00000X
UT314751-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU55992Medicare UPIN
UT1131960001Medicare NSC
UTU55992Medicare UPIN