MEDICARE: WALTER SPEARS MD INC

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	207Q00000X	Family Medicine Physician	G34441	CA

General Provider Information

NPI Number	:	1558391359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER SPEARS MD INC

Provider Business Mailing Address
First Line	:	2595 E WASHINGTON BLVD
Second Line	:	SUITE 107
City	:	PASADENA
State	:	CA
Zip	:	91107-1409
Country	:	US
Telephone Number	:	626-791-1168
Fax Number	:	626-791-4737

Provider Business Practice Location Address
First Line	:	2595 E WASHINGTON BLVD
Second Line	:	SUITE 107
City	:	PASADENA
State	:	CA
Zip	:	91107-1409
Country	:	US
Telephone Number	:	626-791-1168
Fax Number	:	626-791-4737

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. JEAN SPEARS
Credential	:
Telephone Number	:	626-791-1168

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	12/30/2008

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