Healthcare Provider Details

I. General information

NPI: 1649257320
Provider Name (Legal Business Name): JOHN DANIEL KASPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 TOWN CENTER DR
ANNISTON AL
36205-4102
US

IV. Provider business mailing address

P O BOX 5430
ANNISTON AL
36205
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-1624
  • Fax: 256-241-2277
Mailing address:
  • Phone: 256-237-1624
  • Fax: 256-241-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number160473
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number33788
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: