Healthcare Provider Details

I. General information

NPI: 1205406436
Provider Name (Legal Business Name): MATTHEW BATTEL SPEAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/27/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 MEAD DR
BOULDER CO
80301-5111
US

IV. Provider business mailing address

4900 MUELLER BLVD
AUSTIN TX
78723-3079
US

V. Phone/Fax

Practice location:
  • Phone: 847-644-2392
  • Fax:
Mailing address:
  • Phone: 512-324-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number726583
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: