Healthcare Provider Details

I. General information

NPI: 1538277611
Provider Name (Legal Business Name): GREGORY SPEARS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

IV. Provider business mailing address

7619 W JEFFERSON BLVD
FORT WAYNE IN
46804-4133
US

V. Phone/Fax

Practice location:
  • Phone: 260-407-8000
  • Fax: 260-407-8004
Mailing address:
  • Phone: 260-407-8000
  • Fax: 260-407-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34565
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number34565
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: