Provider Demographics
NPI:1013958404
Name:SPEYER, DENITA FAYE (MD)
Entity type:Individual
Prefix:
First Name:DENITA
Middle Name:FAYE
Last Name:SPEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:OBHG
Mailing Address - Street 2:777 LOWNDES HILL ROAD, BUILDING 1
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-516-8798
Mailing Address - Fax:864-516-8798
Practice Address - Street 1:777 LOWNDES HILL ROAD,
Practice Address - Street 2:BUILDING 1
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-576-8798
Practice Address - Fax:864-516-8798
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045320174400000X
TXU4346207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE82005Medicare UPIN