Provider Demographics
NPI:1588695902
Name:HARPER, BARON DWAYNE (MD)
Entity type:Individual
Prefix:
First Name:BARON
Middle Name:DWAYNE
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 1:401 I ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5626
Mailing Address - Country:US
Mailing Address - Phone:530-743-5125
Mailing Address - Fax:530-743-4528
Practice Address - Street 1:401 I ST
Practice Address - Street 2:SUITE A
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5626
Practice Address - Country:US
Practice Address - Phone:530-743-5125
Practice Address - Fax:530-743-4528
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088122208G00000X
CAG88253208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G882530OtherBLUE SHIELD PIN #
IL036088122Medicaid
CAP00659512OtherRAILROAD MEDICARE
020021894OtherRAILROAD MEDICARE
WI32030700Medicaid
CA1588695902Medicaid
CA00G882530OtherBLUE SHIELD PIN #
WI32030700Medicaid