Provider Demographics
NPI:1639151293
Name:GASPER, MICHELE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LYNN
Last Name:GASPER
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 1:275 SE CABOT DR
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3715
Mailing Address - Country:US
Mailing Address - Phone:360-675-5555
Mailing Address - Fax:
Practice Address - Street 1:275 SE CABOT DR
Practice Address - Street 2:SUITE B-102
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3715
Practice Address - Country:US
Practice Address - Phone:360-675-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60496544208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics