Healthcare Provider Details

I. General information

NPI: 1477194488
Provider Name (Legal Business Name): JOE SPEER, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ELM PL STE 225
BROKEN ARROW OK
74012-7825
US

IV. Provider business mailing address

2950 S ELM PL STE 225
BROKEN ARROW OK
74012-7825
US

V. Phone/Fax

Practice location:
  • Phone: 918-550-4446
  • Fax: 918-550-8069
Mailing address:
  • Phone: 918-550-4446
  • Fax: 918-550-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOE B SPEER
Title or Position: PROPRIETOR
Credential: MD
Phone: 918-550-4446