Provider Demographics
NPI:1689616450
Name:KASPER, CANDACE SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:SUE
Last Name:KASPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2840 KELLER SPRINGS RD
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4829
Mailing Address - Country:US
Mailing Address - Phone:214-483-2100
Mailing Address - Fax:214-483-2104
Practice Address - Street 1:2840 KELLER SPRINGS RD
Practice Address - Street 2:SUITE 1104
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-4829
Practice Address - Country:US
Practice Address - Phone:214-483-2100
Practice Address - Fax:214-483-2104
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9650207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE03338Medicare UPIN
TX85W080Medicare ID - Type Unspecified