Provider Demographics
NPI:1578935227
Name:SPEISER, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:SPEISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CHEROKEE DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-1681
Mailing Address - Country:US
Mailing Address - Phone:660-886-8837
Mailing Address - Fax:
Practice Address - Street 1:615 CHEROKEE DR
Practice Address - Street 2:SUITE 8
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-1681
Practice Address - Country:US
Practice Address - Phone:660-886-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies