Provider Demographics
NPI:1699824649
Name:JENNIFER L VESPER MD PA
Entity Type:Organization
Organization Name:JENNIFER L VESPER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:VESPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-748-3376
Mailing Address - Street 1:300 RIVERSIDE DR E
Mailing Address - Street 2:SUITE #2200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1008
Mailing Address - Country:US
Mailing Address - Phone:941-748-3376
Mailing Address - Fax:941-748-7562
Practice Address - Street 1:300 RIVERSIDE DR E
Practice Address - Street 2:SUITE #2200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1008
Practice Address - Country:US
Practice Address - Phone:941-748-3376
Practice Address - Fax:941-748-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0303Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER