Healthcare Provider Details

I. General information

NPI: 1821058868
Provider Name (Legal Business Name): JILL M JASPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT STREET BLANK CHILDREN'S HOSPITAL
DES MOINES IA
50309
US

IV. Provider business mailing address

1200 PLEASANT ST
DES MOINES IA
50309
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-6611
  • Fax: 515-241-6635
Mailing address:
  • Phone: 515-241-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD-38946
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: