Provider Information for 1114799913
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SAMUEL JOSEPH GASPARD
Sex: Male
NPI: 1114799913
Last Updated: 2023-10-25
Certification Date: 2023-10-25
Certification Date: 2023-10-25
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1114799913 | ||||||||
| Enumeration Date | 2023-10-25 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5900 BALCONES DR STE 14306 AUSTIN, TX 78731-4257 United States Phone: 832-693-8504 | Fax: | ||||||||
| Primary Practice Address | 14855 LIBERTY ST MONTGOMERY, TX 77356-4631 United States Phone: 936-483-2407 | Fax: | ||||||||
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