Provider Demographics
NPI:1942209747
Name:HARPER, DONALD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALLEN
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 1:451 FOREST POND LN
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7043
Mailing Address - Country:US
Mailing Address - Phone:912-547-5511
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT ROOTS DR BLDG 66
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:912-547-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0543882085R0202X
ARN-65212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA853110901AMedicaid
GAP00095280OtherRR MEDICARE
SCG54388Medicaid
GA989136OtherBCBS
GA989136OtherBCBS
SCG54388Medicaid