Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 01070774A | IN |
Y | 2081P2900X | Pain Medicine | 01070774A | IN |
NPI | 1356535884 |
---|---|
Provider Name | Dr. Nicholas Robert Jasper |
First Address | Indianapolis, IN 46278-1381 |
Second Address | Indianapolis, IN 46278-1381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201075380 | (05) | IN |