Provider Demographics
NPI:1942594965
Name:SPEARS, BILLY JOE (KRM)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:JOE
Last Name:SPEARS
Suffix:
Gender:M
Credentials:KRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W LODI AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3302
Mailing Address - Country:US
Mailing Address - Phone:209-712-7611
Mailing Address - Fax:
Practice Address - Street 1:806 W LODI AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3302
Practice Address - Country:US
Practice Address - Phone:209-712-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist