Healthcare Provider Details

I. General information

NPI: 1851300875
Provider Name (Legal Business Name): JOHN J JASPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27100 CHARDON RD # 100
RICHMOND HTS OH
44143-1116
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-347-9975
  • Fax: 440-347-0930
Mailing address:
  • Phone: 440-347-9975
  • Fax: 440-347-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-075623
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: