MEDICARE: DR. KENNETH A. SPEARMAN 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	2085R0202X	Diagnostic Radiology Physician	246442	MA
2	2085R0204X	Vascular & Interventional Radiology Physician	A121386	CA

General Provider Information

NPI Number	:	1912107772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A. SPEARMAN MD

Provider Business Mailing Address
First Line	:	880 OAK PARK BLVD STE 201
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-1821
Country	:	US
Telephone Number	:	805-473-8346
Fax Number	:	805-473-2158

Provider Business Practice Location Address
First Line	:	880 OAK PARK BLVD STE 201
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-1821
Country	:	US
Telephone Number	:	805-473-8346
Fax Number	:	805-473-2158

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	05/25/2022

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