Provider Demographics
NPI:1811085244
Name:HARPER, DAN ORVILLE (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:ORVILLE
Last Name:HARPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:O
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:509 S. CEDROS AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075
Mailing Address - Country:US
Mailing Address - Phone:858-755-1126
Mailing Address - Fax:858-755-3530
Practice Address - Street 1:509 S. CEDROS AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075
Practice Address - Country:US
Practice Address - Phone:858-755-1126
Practice Address - Fax:858-755-3530
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51231207Q00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16619Medicare UPIN