Jasper, Bruce A

Jasper, Bruce A is an individual health care provider with primary practice located at 6861 Villagreen Vw , Rockford IL 61107-5639. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Jasper, Bruce A can be contacted via phone (815) 637-6200.

Contact Information

Primary practice address
6861 Villagreen Vw Rockford IL 61107-5639
Phone: (815) 637-6200
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 036-064222 Illinois

Profile Details

NPI number 1073511309
LBN Legal business name Jasper, Bruce A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2005
Last updated Jul 1st, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073511309 NPPES
Wisconsin Other 30492800 WISCONSIN MEDICAID
Wisconsin MEDICAID 036064222 WISCONSIN MEDICAID

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