Provider Demographics
NPI:1972551455
Name:HARPER, KENNETH EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EUGENE
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 1:1705 RENAISSANCE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3041
Mailing Address - Country:US
Mailing Address - Phone:405-285-6901
Mailing Address - Fax:405-285-6902
Practice Address - Street 1:1705 RENAISSANCE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3041
Practice Address - Country:US
Practice Address - Phone:405-285-6901
Practice Address - Fax:405-285-6902
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK115522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100082870AMedicaid
OK242312902Medicare PIN
OKOK400686Medicare PIN
E28969Medicare UPIN