Provider Demographics
NPI:1003801655
Name:SPEIGHT, MARK O (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:O
Last Name:SPEIGHT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1258 MANN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5547
Mailing Address - Country:US
Mailing Address - Phone:704-847-2022
Mailing Address - Fax:704-847-1830
Practice Address - Street 1:1258 MANN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5547
Practice Address - Country:US
Practice Address - Phone:704-847-2022
Practice Address - Fax:704-847-1830
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2015-04-02
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Provider Licenses
StateLicense IDTaxonomies
NC9401496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D17678Medicare UPIN
NC8977557Medicaid
D17678Medicare UPIN