Provider Demographics
NPI:1730242801
Name:CAPPS, HAROLD R (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:R
Last Name:CAPPS
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:TEXAS TECH UNIVERSITY STUDENT HEALTH CLINIC
Mailing Address - Street 2:3601 4TH STREET-MS 7208
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-0001
Mailing Address - Country:US
Mailing Address - Phone:806-743-2860
Mailing Address - Fax:806-743-2122
Practice Address - Street 1:TEXAS TECH UNIVERSITY STUDENT HEALTH CLINIC
Practice Address - Street 2:FLINT AND MAIN, TEXAS TECH UNIVERSITY CAMPUS
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0001
Practice Address - Country:US
Practice Address - Phone:806-743-2860
Practice Address - Fax:806-743-2122
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2022-09-15
Deactivation Date:2019-09-25
Deactivation Code:
Reactivation Date:2022-09-15
Provider Licenses
StateLicense IDTaxonomies
TXE0845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000AD517Medicaid
TXC14176Medicare UPIN
TXP000AD517Medicaid