Healthcare Provider Details

I. General information

NPI: 1215128269
Provider Name (Legal Business Name): MR. DANNY W SPEARS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BENCHOFF RD
GRACEVILLE FL
32440-4601
US

IV. Provider business mailing address

119 BENCHOFF RD
GRACEVILLE FL
32440-4601
US

V. Phone/Fax

Practice location:
  • Phone: 850-638-0183
  • Fax:
Mailing address:
  • Phone: 850-638-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberRG0043089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: