Healthcare Provider Details

I. General information

NPI: 1205041308
Provider Name (Legal Business Name): STEPHEN G GASPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 12/30/2022
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

2204 WHITMAN LN
CARROLLTON TX
75010-4901
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-0424
  • Fax: 248-551-5426
Mailing address:
  • Phone: 713-385-1079
  • Fax: 248-551-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301088309
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN3046
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: