1114971322 NPI number — JOAN MARIE HARTER MD

Table of content: JOAN MARIE HARTER MD (NPI 1114971322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114971322 NPI number — JOAN MARIE HARTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTER
Provider First Name:
JOAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GORI HARTER
Provider Other First Name:
JOAN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114971322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5125 SKYWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARADISE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95969-5624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-872-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2809 OLIVE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE #320
Provider Business Practice Location Address City Name:
OROVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-532-8687
Provider Business Practice Location Address Fax Number:
530-538-3240
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G59177 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G59177 . This is a "BLUE CROSS OF CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G591770 . This is a "BLUE SHIELD OF CA" identifier . This identifiers is of the category "OTHER".




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