Provider Demographics
NPI:1528014081
Name:SPEER, KEVIN P (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:SPEER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3404 WAKE FOREST RD
Mailing Address - Street 2:STE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7341
Mailing Address - Country:US
Mailing Address - Phone:919-256-1511
Mailing Address - Fax:919-256-1530
Practice Address - Street 1:3404 WAKE FOREST RD
Practice Address - Street 2:STE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7341
Practice Address - Country:US
Practice Address - Phone:919-256-1511
Practice Address - Fax:919-256-1530
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC38696207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC78713OtherBCBS
NC8978713Medicaid
2146559BMedicare ID - Type Unspecified
NC8978713Medicaid