Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 147779 | NY |
NPI | 1184673808 |
---|---|
Provider Name | Dr. Brent W Spears |
First Address | Springtown, PA 18081-0502 |
Second Address | Farmingville, NY 11738-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 23/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00695327 | (05) | NY |
017072 | SUBMITTER ID NUMBER (01) | NY |
147779 | STATE LICENSE NUMBER (01) | NY |
161663826 | CORPORATIONS TAX ID NUMBE (01) | NY |
DE6825 | RR MEDICARE PROVIDER NUMBER (01) | NY |
P00308759 | RR MEDICARE (01) |