Provider Demographics
NPI:1326035783
Name:JASPER, DUANE DONALD (MD FP)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:DONALD
Last Name:JASPER
Suffix:
Gender:M
Credentials:MD FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-3155
Mailing Address - Country:US
Mailing Address - Phone:319-334-2541
Mailing Address - Fax:319-334-7054
Practice Address - Street 1:1600 1ST ST E
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-3155
Practice Address - Country:US
Practice Address - Phone:319-334-2541
Practice Address - Fax:319-334-7054
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0029587Medicaid
IA230995Medicare ID - Type Unspecified
IA0029587Medicaid