Organization
BRENT W SPEARS MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT W SPEARS MD (PRESIDENT)
(631) 834-8682
Entity
Organization
Contact information
Practice address
107 BERKSHIRE DR, FARMINGVILLE, NY 11738-2003
(631) 834-8682
Mailing address
PO BOX 502, SPRINGTOWN, PA 18081-0502
(631) 834-8682
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017072
SUBMITTER ID NUMBER
NY
01
—
147779
STATE LICENSE NUMBER
NY
01
—
34309
MASS MEDICAL LICENSE
MA
Enumeration date
06/20/2006
Last updated
10/14/2010
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