Provider Demographics
NPI:1205249588
Name:GASPARD, BLANE SCOTT (CST,CSFA,CSA)
Entity type:Individual
Prefix:
First Name:BLANE
Middle Name:SCOTT
Last Name:GASPARD
Suffix:
Gender:M
Credentials:CST,CSFA,CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 TORTUGA CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-6705
Mailing Address - Country:US
Mailing Address - Phone:615-635-9120
Mailing Address - Fax:
Practice Address - Street 1:1800 MEDICAL CENTER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2568
Practice Address - Country:US
Practice Address - Phone:615-849-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4364246ZS0410X
TN150335246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist