MEDICARE: JOE SPEER, MD, LLC

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	261Q00000X	Clinic/Center
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1477194488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOE SPEER, MD, LLC

Provider Business Mailing Address
First Line	:	2950 S ELM PL STE 225
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7825
Country	:	US
Telephone Number	:	918-550-4446
Fax Number	:	918-550-8069

Provider Business Practice Location Address
First Line	:	2950 S ELM PL STE 225
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7825
Country	:	US
Telephone Number	:	918-550-4446
Fax Number	:	918-550-8069

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	JOE B SPEER
Credential	:	MD
Telephone Number	:	918-550-4446

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	02/10/2025

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