Provider Demographics
NPI:1184991317
Name:HARPER, DEREK W (PA)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:W
Last Name:HARPER
Suffix:
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 1:208 GASLIGHT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3166
Mailing Address - Country:US
Mailing Address - Phone:936-634-0062
Mailing Address - Fax:936-634-0069
Practice Address - Street 1:208 GASLIGHT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3166
Practice Address - Country:US
Practice Address - Phone:936-634-0062
Practice Address - Fax:936-634-0069
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical