Individual
SHANE FOREE SPEARS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, CCP
Contact information
Practice address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 590-5611
Mailing address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 590-5611
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004751
WA
363AS0400X
Surgical Physician Assistant
PA10004751
WA
363AS0400X
Surgical Physician Assistant
Primary
PA15805
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0225125
L&I AND CRIME VICTIMS
WA
05
—
1060261
—
WA
01
—
1425SP
REGENCE
WA
01
—
9468232
AETNA
WA
Enumeration date
01/25/2006
Last updated
03/29/2023
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