Provider Demographics
NPI:1073516480
Name:SPEER, CONNIE LOU (MD)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LOU
Last Name:SPEER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 M D LN
Mailing Address - Street 2:STE A
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5349
Mailing Address - Country:US
Mailing Address - Phone:850-877-1746
Mailing Address - Fax:850-877-8215
Practice Address - Street 1:1407 M D LN
Practice Address - Street 2:STE A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5349
Practice Address - Country:US
Practice Address - Phone:850-877-1746
Practice Address - Fax:850-877-8215
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0369022084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039851900Medicaid
FL37403Medicare ID - Type Unspecified
FLD54610Medicare UPIN