Healthcare Provider Details

I. General information

NPI: 1316701857
Provider Name (Legal Business Name): ISAAC SPEARS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR # 3104
MOBILE AL
36617-2300
US

IV. Provider business mailing address

PO BOX 4482
JACKSON MS
39296-4482
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: