Healthcare Provider Details

I. General information

NPI: 1548238298
Provider Name (Legal Business Name): JOSEPH TIMOTHY SPARE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EXECUTIVE DR STE 201
MARION OH
43302-6302
US

IV. Provider business mailing address

125 EXECUTIVE DR STE 201
MARION OH
43302-6302
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-3087
  • Fax: 740-382-5034
Mailing address:
  • Phone: 740-387-3087
  • Fax: 740-382-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-036582
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: