Healthcare Provider Details

I. General information

NPI: 1982261418
Provider Name (Legal Business Name): SAMUEL THOMAS HARPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 08/22/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 W 761ST TANK BATTALION AVENUE
FORT HOOD TX
76544
US

IV. Provider business mailing address

1711 WILD HORSE LN
ROUND ROCK TX
78681-1869
US

V. Phone/Fax

Practice location:
  • Phone: 254-287-5410
  • Fax:
Mailing address:
  • Phone: 502-974-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023024879
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: