Healthcare Provider Details

I. General information

NPI: 1891786091
Provider Name (Legal Business Name): JOHN VICTOR KASPAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 ED DR
RALEIGH NC
27612-8038
US

IV. Provider business mailing address

3821 ED DR
RALEIGH NC
27612-8038
US

V. Phone/Fax

Practice location:
  • Phone: 919-758-8677
  • Fax: 919-758-8723
Mailing address:
  • Phone: 919-758-8677
  • Fax: 919-758-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number9700609
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number9700609
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: