Provider Demographics
NPI:1629598032
Name:JASPER, CHRISTIAN ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ASHLEY
Last Name:JASPER
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:WAKE FOREST FAMILY MEDICINE - PIEDMONT PLAZA
Mailing Address - Street 2:1920 W. FIRST STREET
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4220
Mailing Address - Country:US
Mailing Address - Phone:336-716-4479
Mailing Address - Fax:336-716-9126
Practice Address - Street 1:1920 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4220
Practice Address - Country:US
Practice Address - Phone:336-716-4479
Practice Address - Fax:336-716-9126
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL40979207Q00000X
NC2020-04721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine