Healthcare Provider Details

I. General information

NPI: 1023503141
Provider Name (Legal Business Name): JENNA SPEARS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10815 W MCDOWELL RD STE 202
AVONDALE AZ
85392-5010
US

IV. Provider business mailing address

3815 E BELL RD STE 4500
PHOENIX AZ
85032-2171
US

V. Phone/Fax

Practice location:
  • Phone: 623-433-0202
  • Fax:
Mailing address:
  • Phone: 571-982-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number78951
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number78951
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: