Healthcare Provider Details

I. General information

NPI: 1265435085
Provider Name (Legal Business Name): TRAVIS M SPEARS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 STONE RD
SAINT JOE AR
72675-1423
US

IV. Provider business mailing address

628 STONE RD
SAINT JOE AR
72675-1423
US

V. Phone/Fax

Practice location:
  • Phone: 870-504-1455
  • Fax:
Mailing address:
  • Phone: 870-504-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number011239
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: