Provider Demographics
NPI:1770822504
Name:DANIEL R. JASPER, LLC
Entity Type:Organization
Organization Name:DANIEL R. JASPER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-872-8822
Mailing Address - Street 1:555 N NEW BALLAS RD
Mailing Address - Street 2:STE 250
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6825
Mailing Address - Country:US
Mailing Address - Phone:314-872-8822
Mailing Address - Fax:314-432-2331
Practice Address - Street 1:555 N NEW BALLAS RD
Practice Address - Street 2:STE 250
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:314-872-8822
Practice Address - Fax:314-432-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty