Provider Demographics
NPI:1245277300
Name:KASPERKHAN, JIBRAIL (MD)
Entity type:Individual
Prefix:DR
First Name:JIBRAIL
Middle Name:
Last Name:KASPERKHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 NORTH LOOP 1604 WEST
Mailing Address - Street 2:SUITE 108-641
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-4500
Mailing Address - Country:US
Mailing Address - Phone:210-479-1955
Mailing Address - Fax:210-491-1801
Practice Address - Street 1:21902 FRANKLIN PARK APT 1308
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2193
Practice Address - Country:US
Practice Address - Phone:210-479-1955
Practice Address - Fax:210-764-1561
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0453207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171891801Medicaid
TX171891801Medicaid
TX0036MHMedicare PIN