MEDICARE: BETH ANN GASPARO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	174464-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	633476	OTHER	UT	DESERET MUTUAL
2	942938348GAS	OTHER	UT	EDUCATORS MUTUAL
3	107009856101	OTHER	UT	INTRMTN. HEALTH CARE

General Provider Information

NPI Number	:	1598736217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH ANN GASPARO M.D.

Provider Business Mailing Address
First Line	:	1850 S 2500 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3242
Country	:	US
Telephone Number	:	801-481-4957
Fax Number	:	801-481-4959

Provider Business Practice Location Address
First Line	:	1850 S 2500 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3242
Country	:	US
Telephone Number	:	801-481-4957
Fax Number	:	801-481-4959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	03/11/2009

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