Provider Demographics
NPI:1588658744
Name:SPEARS, WAYNE T (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:T
Last Name:SPEARS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6950 FRANCE AVE S
Mailing Address - Street 2:# 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2008
Mailing Address - Country:US
Mailing Address - Phone:952-920-4915
Mailing Address - Fax:952-915-6091
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4702
Practice Address - Country:US
Practice Address - Phone:952-993-6032
Practice Address - Fax:952-993-5512
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2016-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN334102085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2400004OtherMEDICA PRIMARY
MN25141OtherAMERICA'S PPO
MN40635SPOtherBLUE CROSS/BLUE SHIELD
MN104842OtherUCARE
MN2419297OtherMEDICA
MN889200800Medicaid
MNHP14447OtherHEALTH PARTNERS
MN110587OtherPATIENT CHOICE
MN963070250009OtherPREFERRED ONE
MN25141OtherAMERICA'S PPO
MN2419297OtherMEDICA
MN40635SPOtherBLUE CROSS/BLUE SHIELD
MNHP14447OtherHEALTH PARTNERS