Healthcare Provider Details

I. General information

NPI: 1427580570
Provider Name (Legal Business Name): MEAGAN SPEAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST
GULFPORT MS
39501-2569
US

IV. Provider business mailing address

4500 13TH ST
GULFPORT MS
39501-2569
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27833
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: