Provider Demographics
NPI:1871588368
Name:SPEAR, J. MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:MICHAEL
Last Name:SPEAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-246-6777
Mailing Address - Fax:423-246-7766
Practice Address - Street 1:235 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7455
Practice Address - Country:US
Practice Address - Phone:423-246-6777
Practice Address - Fax:423-246-7766
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD014427207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100026287OtherPHP TENNCARE
VA283685OtherANTHEM
VA005831423Medicaid
TN4546278OtherAETNA
TN3122028OtherBCBS OF TN
TN3700035Medicaid
TNTN0112OtherUNITED HEALTHCARE RIVER V
WV0227812000Medicaid
KY64776750Medicaid
VA005831423Medicaid
TN100026287OtherPHP TENNCARE
TN100012862Medicare ID - Type UnspecifiedRAILROAD
WV0227812000Medicaid