Provider Demographics
NPI:1891726220
Name:RANDALL, L HARPER (MD)
Entity Type:Individual
Prefix:
First Name:L
Middle Name:HARPER
Last Name:RANDALL
Suffix:
Gender:F
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:PO BOX 144610
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84114-4610
Mailing Address - Country:US
Mailing Address - Phone:801-584-8239
Mailing Address - Fax:801-584-8488
Practice Address - Street 1:44 N MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-584-8239
Practice Address - Fax:801-584-8488
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1789321205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22837Medicare UPIN
000010420Medicare ID - Type Unspecified