MEDICARE: MARK A SPEARS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME 66124	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	25211X	OTHER	FL	FL MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25211	OTHER	FL	BCBS OF FL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023057999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A SPEARS M.D.

Provider Business Mailing Address
First Line	:	1665 W BROADWAY ST STE 1021
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-7854
Country	:	US
Telephone Number	:	407-326-8223
Fax Number	:	407-646-7995

Provider Business Practice Location Address
First Line	:	1665 W BROADWAY ST STE 1021
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-7854
Country	:	US
Telephone Number	:	407-326-8223
Fax Number	:	407-646-7995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/13/2024

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Directions to “ MARK A SPEARS M.D.” Practice Location

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