Provider Demographics
NPI:1265497804
Name:VESPER, JENNIFER L (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:VESPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RIVERSIDE DR E
Mailing Address - Street 2:#2200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1008
Mailing Address - Country:US
Mailing Address - Phone:941-748-3376
Mailing Address - Fax:941-748-7562
Practice Address - Street 1:300 RIVERSIDE DR E
Practice Address - Street 2:#2200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1008
Practice Address - Country:US
Practice Address - Phone:941-748-3376
Practice Address - Fax:941-748-7562
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066265207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG11156Medicare UPIN
FL27216ZMedicare ID - Type Unspecified