Provider Demographics
NPI:1528002466
Name:SPEAR, DAVE S (MD)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:S
Last Name:SPEAR
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:PO BOX 802001
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-3831
Mailing Address - Country:US
Mailing Address - Phone:432-528-1985
Mailing Address - Fax:817-496-5151
Practice Address - Street 1:1301 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2122
Practice Address - Country:US
Practice Address - Phone:817-882-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9719207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122166505Medicaid
TX0073LBOtherBLUECROSS BLUESHIELD
TX610536Medicare PIN
TX0073LBOtherBLUECROSS BLUESHIELD
TX122166505Medicaid