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NPI Code Detail

MEDICARE: MR. DOUGLAS J SPEAR MA CCC A

MEDICARE: MR. DOUGLAS J SPEAR MA CCC A
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
1231H00000XAudiologist0154KY
2237700000XHearing Instrument Specialist0496KY
3237700000XHearing Instrument Specialist101441KY
4231H00000XAudiologist100064KY

General Provider Information

NPI Number : 1649257817
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS J SPEAR MA CCC A
Provider Business Mailing Address
First Line : 320 LINDENHURST DR APT 12202
Second Line :
City : LEXINGTON
State : KY
Zip : 40509-1379
Country : US
Telephone Number : 859-608-3757
Fax Number :
Provider Business Practice Location Address
First Line : 117 E KENTUCKY ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40203-2793
Country : US
Telephone Number : 502-584-3573
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 09/14/2023

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