Healthcare Provider Details

I. General information

NPI: 1750129672
Provider Name (Legal Business Name): SHANE SPEIRS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35800 BOB HOPE DR STE 225
RANCHO MIRAGE CA
92270-1740
US

IV. Provider business mailing address

501 N 44TH ST STE 450
PHOENIX AZ
85008-6526
US

V. Phone/Fax

Practice location:
  • Phone: 760-673-7010
  • Fax: 760-673-7911
Mailing address:
  • Phone: 602-491-0701
  • Fax: 480-631-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANE RYAN SPEIRS
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 602-491-0701