Healthcare Provider Details

I. General information

NPI: 1922121318
Provider Name (Legal Business Name): JASPER JAMES CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E 18TH ST
CHEYENNE WY
82001-5511
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-633-7370
  • Fax: 307-633-7202
Mailing address:
  • Phone: 307-633-7370
  • Fax: 307-633-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9550A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: