Provider Demographics
NPI:1548238777
Name:SPEERS, WENDELL CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:CARL
Last Name:SPEERS
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 30309
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0309
Mailing Address - Country:US
Mailing Address - Phone:843-284-3400
Mailing Address - Fax:843-566-8780
Practice Address - Street 1:6116 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5752
Practice Address - Country:US
Practice Address - Phone:303-512-0888
Practice Address - Fax:303-512-2288
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19497207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ641763Medicaid
NM82805032Medicaid
UTZ8167Medicaid
CO01194976Medicaid
COC220528Medicare PIN
AZ641763Medicaid