Provider Demographics
NPI:1134102551
Name:JASPER, JOSEPH F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:F
Last Name:JASPER
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 65017
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98464-1017
Mailing Address - Country:US
Mailing Address - Phone:253-686-9825
Mailing Address - Fax:
Practice Address - Street 1:2611 LEMONS BEACH RD W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-1833
Practice Address - Country:US
Practice Address - Phone:253-686-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0020206207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1099548Medicaid
WA8457608Medicaid
WA8328593Medicaid
WAGAB18031Medicare ID - Type Unspecified
WA8328593Medicaid
WA8457608Medicaid
WAA20458Medicare UPIN
WAGAB14055Medicare PIN
WAGGAB14055Medicare PIN