Healthcare Provider Details

I. General information

NPI: 1720582778
Provider Name (Legal Business Name): BRADLEY JAMES KASPER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2078 WINTER SPRINGS BLVD
OVIEDO FL
32765-9347
US

IV. Provider business mailing address

977 PARK TERRACE CIR
KISSIMMEE FL
34746-6129
US

V. Phone/Fax

Practice location:
  • Phone: 407-453-2072
  • Fax: 407-601-1053
Mailing address:
  • Phone: 904-537-5087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS19017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: