Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0116022730 | VA |
Y | 207Q00000X | Family Doctor | 2819 | TN |
N | 207Q00000X | Family Doctor | 35703 | SC |
N | 207QS0010X | Family Doctor - Sports Medicine | 2819 | TN |
N | 207QS0010X | Family Doctor - Sports Medicine | 35703 | SC |
NPI | 1053632018 |
---|---|
Provider Name | Dr. Owen F Speer |
First Address | Hixson, TN 37343 |
Second Address | Hixson, TN 37343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2010 |
Last Update Date | 08/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
357036 | (05) | SC |