Provider Demographics
NPI:1700925740
Name:HARPER, AMANDA COKER (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:COKER
Last Name:HARPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 COLUMBIA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2634
Mailing Address - Country:US
Mailing Address - Phone:505-220-9443
Mailing Address - Fax:
Practice Address - Street 1:7520 MONTGOMERY BLVD NE BLDG D4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1533
Practice Address - Country:US
Practice Address - Phone:505-884-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0235207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology