Provider Demographics
NPI:1467677815
Name:SPEAR, MERRITT FULLER I (MD)
Entity Type:Individual
Prefix:DR
First Name:MERRITT
Middle Name:FULLER
Last Name:SPEAR
Suffix:I
Gender:M
Credentials:MD
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Mailing Address - Street 1:2985 MAIN ST.,RTE 22
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-2927
Mailing Address - Country:US
Mailing Address - Phone:518-643-8443
Mailing Address - Fax:518-643-8443
Practice Address - Street 1:STATE UNIVERSITY NEW YORK
Practice Address - Street 2:1010 BROAD ST
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-564-2187
Practice Address - Fax:518-564-2188
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY086460-1207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY32991BMedicare ID - Type UnspecifiedPROVIDER NUMBER
NYDO1947Medicare UPIN