Provider Demographics
NPI:1104240159
Name:SPEARS, ALAN GERARD
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:GERARD
Last Name:SPEARS
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 1:1275 N BANANA RIVER DR UNIT 5
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-5788
Mailing Address - Country:US
Mailing Address - Phone:321-454-9528
Mailing Address - Fax:321-454-9528
Practice Address - Street 1:1275 N BANANA RIVER DR UNIT 5
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-5788
Practice Address - Country:US
Practice Address - Phone:321-454-9528
Practice Address - Fax:321-454-9528
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 11441310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility