Healthcare Provider Details

I. General information

NPI: 1639173156
Provider Name (Legal Business Name): TIMOTHY C. SPEARS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S WASHINGTON AVE
IOLA KS
66749-3256
US

IV. Provider business mailing address

1408 EAST STREET
IOLA KS
66749-3004
US

V. Phone/Fax

Practice location:
  • Phone: 620-365-0151
  • Fax: 800-713-3493
Mailing address:
  • Phone: 620-365-3115
  • Fax: 620-365-7717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0523246
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: