Healthcare Provider Details

I. General information

NPI: 1649339417
Provider Name (Legal Business Name): BRUCE A. SPERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WINDTREE CIR
CARSON CITY NV
89701-6086
US

IV. Provider business mailing address

31 WINDTREE CIR
CARSON CITY NV
89701-6086
US

V. Phone/Fax

Practice location:
  • Phone: 775-721-6884
  • Fax:
Mailing address:
  • Phone: 775-721-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7904
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: