Provider Demographics
NPI:1720098205
Name:HARPER, JOHN R III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:HARPER
Suffix:III
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 1:1834 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065
Mailing Address - Country:US
Mailing Address - Phone:760-789-2629
Mailing Address - Fax:760-788-3235
Practice Address - Street 1:1834 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2522
Practice Address - Country:US
Practice Address - Phone:760-789-2629
Practice Address - Fax:760-788-3235
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80250207P00000X, 2083X0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A802500Medicaid
CA00A802500Medicaid
CAWA80250AMedicare ID - Type Unspecified