Provider Demographics
NPI:1548435688
Name:HARPER, RONALD RAY JR (PA)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:RAY
Last Name:HARPER
Suffix:JR
Gender:M
Credentials:PA
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 775985
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5985
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:14535A HAZEL DELL PKWY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-9401
Practice Address - Country:US
Practice Address - Phone:317-705-4392
Practice Address - Fax:317-705-4391
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000988A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00814090OtherRAILROAD MEDICARE
IN300013439Medicaid
IN000000564609OtherANTHEM
IN000000625094OtherANTHEM
IN177280B7Medicare PIN
IN259950KMedicare PIN