Provider Demographics
NPI:1215164843
Name:JIBRAIL KASPERKHAN, M.D. PLLC
Entity type:Organization
Organization Name:JIBRAIL KASPERKHAN, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JIBRAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KASPERKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-479-1955
Mailing Address - Street 1:1150 N LOOP 1604 W
Mailing Address - Street 2:SUITE 108-641
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-4503
Mailing Address - Country:US
Mailing Address - Phone:210-479-1955
Mailing Address - Fax:210-764-1561
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0453207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty