Provider Demographics
NPI:1154837680
Name:JOSEPHINE V JASPER MD PA
Entity Type:Organization
Organization Name:JOSEPHINE V JASPER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-768-4944
Mailing Address - Street 1:1904 SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-6703
Mailing Address - Country:US
Mailing Address - Phone:973-768-4944
Mailing Address - Fax:
Practice Address - Street 1:40 S HEATHWOOD DR STE E
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-5026
Practice Address - Country:US
Practice Address - Phone:239-315-8271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128241207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty