Healthcare Provider Details

I. General information

NPI: 1326084302
Provider Name (Legal Business Name): BRENT W SPEARS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 BERKSHIRE DR
FARMINGVILLE NY
11738-2003
US

IV. Provider business mailing address

PO BOX 502
SPRINGTOWN PA
18081-0502
US

V. Phone/Fax

Practice location:
  • Phone: 631-834-8682
  • Fax:
Mailing address:
  • Phone: 631-834-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. BRENT W SPEARS
Title or Position: PRESIDENT
Credential: MD
Phone: 631-834-8682