Provider Demographics
NPI:1578112033
Name:MARK SPEARS MD PLLC
Entity Type:Organization
Organization Name:MARK SPEARS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-505-7380
Mailing Address - Street 1:3484 GATWICK MANOR LN
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8405
Mailing Address - Country:US
Mailing Address - Phone:321-505-7380
Mailing Address - Fax:
Practice Address - Street 1:5600 PORADA DR STE 103
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-8082
Practice Address - Country:US
Practice Address - Phone:321-505-7380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty