Provider Demographics
NPI:1598736217
Name:GASPARO, BETH ANN (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:GASPARO
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 1:1850 S 2500 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3242
Mailing Address - Country:US
Mailing Address - Phone:801-481-4957
Mailing Address - Fax:801-481-4959
Practice Address - Street 1:1850 S 2500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-3242
Practice Address - Country:US
Practice Address - Phone:801-481-4957
Practice Address - Fax:801-481-4959
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174464-12052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT633476OtherDESERET MUTUAL
UT942938348GASOtherEDUCATORS MUTUAL
UT107009856101OtherINTRMTN. HEALTH CARE