Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 2003031159 | MO |
NPI | 1043315385 |
---|---|
Provider Name | Dr. John D Spears |
First Address | Jefferson City, MO 65109-5677 |
Second Address | Jefferson City, MO 65109-5677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 09/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208747808 | (05) | MO |
H90087 | (02) | MO |