1609947993 NPI number — JAROD E SPEER M.D.

Table of content: JAROD E SPEER M.D. (NPI 1609947993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609947993 NPI number — JAROD E SPEER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPEER
Provider First Name:
JAROD
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609947993
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHILDERSBURG
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35044-0349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-378-3313
Provider Business Mailing Address Fax Number:
256-378-5912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34011 US HIGHWAY 280
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CHILDERSBURG
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35044-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-378-3313
Provider Business Practice Location Address Fax Number:
256-378-5912
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  27731 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80252 . This is a "COMMERCIAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00392428 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51590048 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 200356379 . This is a "TRICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1952484081 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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