Provider Demographics
NPI:1215908777
Name:HARP, GREGORY MERRILL (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MERRILL
Last Name:HARP
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 1:1684 SW KNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1005
Mailing Address - Country:US
Mailing Address - Phone:541-383-1662
Mailing Address - Fax:
Practice Address - Street 1:1302 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4333
Practice Address - Country:US
Practice Address - Phone:541-388-7799
Practice Address - Fax:541-389-4096
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17079207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD17079OtherMEDICAL LICENSE
OR061684Medicaid
ORAH2172168OtherDEA
OR061684Medicaid
OR101958Medicare ID - Type UnspecifiedMEDICARE