=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154837680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPHINE V JASPER MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2017
-----------------------------------------------------
Last Update Date | 12/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 S HEATHWOOD DR STE E
-----------------------------------------------------
City | MARCO ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34145-5026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-315-8271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1904 SHEFFIELD AVE
-----------------------------------------------------
City | MARCO ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34145-6703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-768-4944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOSEPHINE V JASPER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 973-768-4944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | ME128241
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------