Provider Demographics
NPI:1659330090
Name:SPECA, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:SPECA
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 1:785 OHIO AVE STE 1H
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6213
Mailing Address - Country:US
Mailing Address - Phone:662-621-2438
Mailing Address - Fax:
Practice Address - Street 1:785 OHIO AVE STE 1H
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6213
Practice Address - Country:US
Practice Address - Phone:662-621-2438
Practice Address - Fax:662-621-2469
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070970207X00000X
TN47677207X00000X
MS23479207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01676197OtherRAILROAD MEDICARE PTAN
IL036070970Medicaid
MS08870040Medicaid
IL036070970Medicaid
MS08870040Medicaid