Provider Demographics
NPI:1710487616
Name:TEJAN, GASPER
Entity Type:Individual
Prefix:
First Name:GASPER
Middle Name:
Last Name:TEJAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 JENNIFER ST
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4734
Mailing Address - Country:US
Mailing Address - Phone:469-230-8808
Mailing Address - Fax:
Practice Address - Street 1:1512 JENNIFER ST
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4734
Practice Address - Country:US
Practice Address - Phone:469-230-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229272164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse