Provider Demographics
NPI:1649257817
Name:SPEAR, DOUGLAS J (MA CCC A)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:J
Last Name:SPEAR
Suffix:
Gender:M
Credentials:MA CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LINDENHURST DR APT 12202
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1379
Mailing Address - Country:US
Mailing Address - Phone:859-608-3757
Mailing Address - Fax:
Practice Address - Street 1:117 E KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2793
Practice Address - Country:US
Practice Address - Phone:502-584-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0154231H00000X
KY0496237700000X
KY101441237700000X
KY100064231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P70474Medicare UPIN
0734401Medicare ID - Type Unspecified