Provider Demographics
NPI:1942307947
Name:SPEARS, JASON T (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:SPEARS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8120 TIMBERLAKE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5412
Practice Address - Country:US
Practice Address - Phone:916-681-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8586207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A85860OtherBLUE SHIELD
CA1911642OtherGREAT WEST
CA256746OtherINTERPLAN
CA20A8586OtherBLUE CROSS
CA90199250OtherPACIFICARE
CAMCMG424900OtherWESTERN HEALTH ADVANTAGE
CA000810711127OtherPHCS
CA00AX85860Medicaid
CA2421184OtherUNITED HEALTHCARE
CA7350671OtherAETNA
CA112733OtherHEALTH NET
CA4683565OtherCIGNA
CA020A85860OtherBLUE SHIELD
CA020A85861Medicare ID - Type Unspecified