MEDICARE: DR. HUBERT EARL SPEARS JR. M.D.

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	2086X0206X	Surgical Oncology Physician	09189	MS
2	208C00000X	Colon & Rectal Surgery Physician	09189	MS
3	208600000X	Surgery Physician	09189	MS

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	:	1538196845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUBERT EARL SPEARS JR. M.D.

Provider Business Mailing Address
First Line	:	400 REBEL DRIVE
Second Line	:
City	:	UNIVERSITY
State	:	MS
Zip	:	38677-5223
Country	:	US
Telephone Number	:	662-915-6550
Fax Number	:	629-152-0226

Provider Business Practice Location Address
First Line	:	400 REBEL DRIVE
Second Line	:
City	:	UNIVERSITY
State	:	MS
Zip	:	38677
Country	:	US
Telephone Number	:	662-915-6550
Fax Number	:	662-915-2022

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	10/04/2018

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