MEDICARE: DR. MARCUS GAYLON SPEER P. 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	183500000X	Pharmacist	PD05156	AR

General Provider Information

NPI Number	:	1699787036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS GAYLON SPEER P. D.

Provider Business Mailing Address
First Line	:	6004 EAGLE CREEK RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-5778
Country	:	US
Telephone Number	:	501-835-7603
Fax Number	:	501-835-3025

Provider Business Practice Location Address
First Line	:	7311 N HILLS BLVD
Second Line	:	SUITE NO. 3
City	:	SHERWOOD
State	:	AR
Zip	:	72116-5355
Country	:	US
Telephone Number	:	501-835-7775
Fax Number	:	501-835-3025

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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