Healthcare Provider Details

I. General information

NPI: 1023033909
Provider Name (Legal Business Name): JASPER FAMILY PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SAINT CHARLES ST SUITE 4
JASPER IN
47546-9172
US

IV. Provider business mailing address

1950 SAINT CHARLES ST SUITE 4
JASPER IN
47546-2254
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-9555
  • Fax: 812-482-9073
Mailing address:
  • Phone: 812-482-9555
  • Fax: 812-482-9073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50003215A
License Number StateIN

VIII. Authorized Official

Name: DR. DEAN E. BECKMAN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 812-482-9555