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General NPI Number Information
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NPI Number | 1578848792
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Entity Type | Individual
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Provider Name | JUSTIN JOHN GASPER D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 3402 ANDERSON HEALTHCARE DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-7712
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Country | US
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Telephone | 618-307-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 1776 WOODSTEAD CT STE 208
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City | THE WOODLANDS
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State | TX
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Zip | 77380-1480
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Country | US
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Telephone | 877-749-7428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 2015011363
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 036.167006
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036.167006
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0102203750
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | BP10040290
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2015011363
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License Number State | MO
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