Provider Demographics
NPI:1790738300
Name:SPEHAR, PASCAL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PASCAL
Middle Name:EDWARD
Last Name:SPEHAR
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 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:1601 W TIMBERLANE DR STE 100
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-0957
Practice Address - Country:US
Practice Address - Phone:813-708-1312
Practice Address - Fax:813-443-8147
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133800208600000X
MO105155208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO23583OtherBNDD
FL102297200Medicaid
MO203902002Medicaid
BS2072154OtherDEA