Provider Demographics
NPI:1447339684
Name:SPEAR, JESSE LYNN (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:LYNN
Last Name:SPEAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11725 N ILLINOIS ST
Practice Address - Street 2:SUITE 595
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3008
Practice Address - Country:US
Practice Address - Phone:317-688-5522
Practice Address - Fax:317-688-5533
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061024A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000679049OtherANTHEM BCBS (SVMG)
IN200921080Medicaid
IN200921080Medicaid
INM400056637Medicare PIN
IN940550O2Medicare PIN
INM400029777Medicare PIN