Provider Demographics
NPI:1083783708
Name:GASPARRE, RICHARD R (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:GASPARRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18252
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-0252
Mailing Address - Country:US
Mailing Address - Phone:775-971-4518
Mailing Address - Fax:888-574-1074
Practice Address - Street 1:6410 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1103
Practice Address - Country:US
Practice Address - Phone:775-322-5757
Practice Address - Fax:775-322-5776
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10951149OtherCAQH
10951149OtherCAQH
NVH59778Medicare UPIN
NVV103847Medicare PIN