MEDICARE: JERRY SPEER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	6147	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235130105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY SPEER MD

Provider Business Mailing Address
First Line	:	PO BOX 6010
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59406-6010
Country	:	US
Telephone Number	:	406-455-4470
Fax Number	:	406-268-0084

Provider Business Practice Location Address
First Line	:	500 15TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4304
Country	:	US
Telephone Number	:	406-455-2130
Fax Number	:	406-455-2138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	05/28/2009

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Directions to “ JERRY SPEER MD” Practice Location

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