Provider Demographics
NPI:1336118686
Name:SPEYERER, DAVID K (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:SPEYERER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4129
Mailing Address - Country:US
Mailing Address - Phone:863-294-0670
Mailing Address - Fax:863-298-3200
Practice Address - Street 1:635 1ST ST N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4129
Practice Address - Country:US
Practice Address - Phone:863-294-0670
Practice Address - Fax:863-298-3200
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME542242086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062027100Medicaid
FL010045982OtherMEDICARE ID/ RRM PIN
FL010045982OtherMEDICARE ID/ RRM PIN
FLE65236Medicare UPIN