Provider Demographics
NPI:1225126972
Name:SPEECE, CONNIE JANEL (DO)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:JANEL
Last Name:SPEECE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10622 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2639
Mailing Address - Country:US
Mailing Address - Phone:214-321-2673
Mailing Address - Fax:214-321-4329
Practice Address - Street 1:10622 GARLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2639
Practice Address - Country:US
Practice Address - Phone:214-321-2673
Practice Address - Fax:214-321-4329
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine