Individual
DR. JOHN M SPECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
785 OHIO AVE STE 1H, CLARKSDALE, MS 38614-6213
(662) 621-2438
(662) 621-2469
Mailing address
785 OHIO AVE STE 1H, CLARKSDALE, MS 38614-6213
(662) 621-2438
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036-070970
IL
207X00000X
Orthopaedic Surgery Physician
Primary
23479
MS
207X00000X
Orthopaedic Surgery Physician
47677
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070970
—
IL
05
—
08870040
—
MS
01
—
P01676197
RAILROAD MEDICARE PTAN
MS
Enumeration date
03/23/2006
Last updated
08/11/2020
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