Healthcare Provider Details

I. General information

NPI: 1326004094
Provider Name (Legal Business Name): WALTER GLEN SPEIRS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9001
US

IV. Provider business mailing address

11400 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9001
US

V. Phone/Fax

Practice location:
  • Phone: 530-432-7023
  • Fax: 530-432-7026
Mailing address:
  • Phone: 530-432-7023
  • Fax: 530-432-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: