Provider Demographics
NPI:1164615571
Name:JASPER, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:JASPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17030 LAKESIDE HILLS PLZ
Mailing Address - Street 2:#102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2396
Mailing Address - Country:US
Mailing Address - Phone:402-758-5800
Mailing Address - Fax:402-758-5809
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ
Practice Address - Street 2:#102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2396
Practice Address - Country:US
Practice Address - Phone:402-758-5800
Practice Address - Fax:402-758-5809
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE11480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE04435OtherBCBS - D4S
NE04430OtherBCBS - IMP
NE042914OtherUHC SHARE ADVANTAGE D4S
NE6398OtherMIDLANDS CHOICE
NE042913OtherUHC SHARE ADVANTAGE IMP
NE04435OtherBCBS - D4S
B67584Medicare UPIN
NE281698Medicare PIN