Healthcare Provider Details

I. General information

NPI: 1780070276
Provider Name (Legal Business Name): CHARLES N SPEAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHARLEY N SPEAR MD

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 W 110TH ST
OVERLAND PARK KS
66211-2504
US

IV. Provider business mailing address

2401 GILLHAM RD PROVIDER ENROLLMENT
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 913-696-8000
  • Fax:
Mailing address:
  • Phone: 816-701-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2022049456
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018010490
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number2022049456
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number04-47753
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: