MEDICARE: MR. REUBEN DARIUS SPEARMAN SR.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1144958596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REUBEN DARIUS SPEARMAN SR.

Provider Business Mailing Address
First Line	:	2927 N COLORADO AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-3116
Country	:	US
Telephone Number	:	317-373-8320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N POST RD # A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4213
Country	:	US
Telephone Number	:	317-282-3088
Fax Number	:	317-295-2555

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	08/12/2022

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