Healthcare Provider Details

I. General information

NPI: 1750409843
Provider Name (Legal Business Name): NEAL SPEARS, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 HIGHWAY 71 W STE C
BASTROP TX
78602-3937
US

IV. Provider business mailing address

PO BOX 359
SMITHVILLE TX
78957-0359
US

V. Phone/Fax

Practice location:
  • Phone: 512-304-0313
  • Fax:
Mailing address:
  • Phone: 512-581-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL4729
License Number StateTX

VIII. Authorized Official

Name: DR. NEAL SPEARS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 512-581-8770