Provider Demographics
NPI:1801122189
Name:SPEARMAN, DONALD RAY
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:RAY
Last Name:SPEARMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 LONG TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-3407
Mailing Address - Country:US
Mailing Address - Phone:318-780-0350
Mailing Address - Fax:318-525-1075
Practice Address - Street 1:3200 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-3620
Practice Address - Country:US
Practice Address - Phone:318-780-0350
Practice Address - Fax:318-525-1075
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1534820Medicaid