Healthcare Provider Details

I. General information

NPI: 1548238777
Provider Name (Legal Business Name): WENDELL CARL SPEERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 E WARREN AVE
DENVER CO
80222-5752
US

IV. Provider business mailing address

PO BOX 30309
CHARLESTON SC
29417-0309
US

V. Phone/Fax

Practice location:
  • Phone: 303-512-0888
  • Fax: 303-512-2288
Mailing address:
  • Phone: 843-284-3400
  • Fax: 843-566-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number19497
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: