Provider Demographics
NPI:1811979743
Name:HARPER, LARRY ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ROBERT
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:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:17000 140TH AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6928
Practice Address - Country:US
Practice Address - Phone:425-481-6363
Practice Address - Fax:425-488-4971
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHA9963OtherBLUE SHIELD
WA080087314OtherMEDICARE RAILROAD
WA1024637Medicaid
WA105504OtherLABOR & INDUSTRIES
WAG8897719Medicare PIN
WA080087314OtherMEDICARE RAILROAD
WAG217120804Medicare PIN