Healthcare Provider Details

I. General information

NPI: 1497724686
Provider Name (Legal Business Name): TAMMY ROSE SPEAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007-G HIGHWAY 150 WEST
SUMMERFIELD NC
27358-9772
US

IV. Provider business mailing address

PO BOX 620658
CHARLOTTE NC
28262-0110
US

V. Phone/Fax

Practice location:
  • Phone: 336-644-7771
  • Fax: 336-644-6118
Mailing address:
  • Phone: 336-716-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9401343
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: