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General NPI Number Information
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NPI Number | 1588658744
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Entity Type | Individual
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Provider Name | WAYNE T SPEARS MD
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Gender | Male
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 6500 EXCELSIOR BLVD
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-4702
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Country | US
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Telephone | 952-993-6032
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Fax | 952-993-5512
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Provider Business Mailing Address
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Address Line | 6950 FRANCE AVE S # 200
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City | EDINA
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State | MN
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Zip | 55435-2008
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Country | US
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Telephone | 952-920-4915
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Fax | 952-915-6091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 33410
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License Number State | MN
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