Provider Demographics
NPI:1164041869
Name:SPEARS, MONIQUE RENESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:RENESHA
Last Name:SPEARS
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 1:1460 E BERT KOUNS INDUSTRIAL LOOP STE 700
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5644
Mailing Address - Country:US
Mailing Address - Phone:318-681-5580
Mailing Address - Fax:
Practice Address - Street 1:1460 E BERT KOUNS INDUSTRIAL LOOP STE 700
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5644
Practice Address - Country:US
Practice Address - Phone:318-681-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA336928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program