Healthcare Provider Details

I. General information

NPI: 1649974098
Provider Name (Legal Business Name): HENRY KENNETH SPEAR III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 IMAGING DR
SOMERSET KY
42503-2869
US

IV. Provider business mailing address

PO BOX 1038
FRANKFORT KY
40602-1038
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-1449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61825
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: