Provider Demographics
NPI:1407138654
Name:KASPAR, GEORGY
Entity Type:Individual
Prefix:
First Name:GEORGY
Middle Name:
Last Name:KASPAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 E SANDPIPER DR
Mailing Address - Street 2:APT#8
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-2464
Mailing Address - Country:US
Mailing Address - Phone:561-309-9075
Mailing Address - Fax:
Practice Address - Street 1:3633 E SANDPIPER DR
Practice Address - Street 2:APT#8
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-2464
Practice Address - Country:US
Practice Address - Phone:561-309-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN16758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine