Provider Demographics
NPI:1194278796
Name:SPEARS, DARRELL JR
Entity type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:
Last Name:SPEARS
Suffix:JR
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 1:23 LAUREL HTS
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-5424
Mailing Address - Country:US
Mailing Address - Phone:860-856-1288
Mailing Address - Fax:
Practice Address - Street 1:23 LAUREL HTS
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-5424
Practice Address - Country:US
Practice Address - Phone:860-856-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001842141146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001842141Other600 890