Provider Demographics
NPI:1053632018
Name:SPEER, OWEN F (DO)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:F
Last Name:SPEER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 HAMILL ROAD SUITE 301
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-877-1249
Mailing Address - Fax:423-870-2765
Practice Address - Street 1:2051 HAMILL ROAD SUITE 301
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-877-1249
Practice Address - Fax:423-870-2765
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116022730207Q00000X
SC35703207Q00000X, 207QS0010X
TN2819207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC357036Medicaid
SCSC36262353Medicare PIN
SCSC36262488Medicare PIN