Provider Demographics
NPI:1124398151
Name:ERIC SPEARE M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ERIC SPEARE M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-493-6633
Mailing Address - Street 1:33971 SELVA RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3788
Mailing Address - Country:US
Mailing Address - Phone:949-493-6633
Mailing Address - Fax:949-493-0669
Practice Address - Street 1:33971 SELVA RD
Practice Address - Street 2:SUITE 150
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3788
Practice Address - Country:US
Practice Address - Phone:949-493-6633
Practice Address - Fax:949-493-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG360432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty