Provider Demographics
NPI:1326004094
Name:SPEIRS, WALTER GLEN (PA-C)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:GLEN
Last Name:SPEIRS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24981
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2000
Mailing Address - Country:US
Mailing Address - Phone:844-969-0686
Mailing Address - Fax:773-832-7083
Practice Address - Street 1:7233 E BASELINE RD STE 126
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-5007
Practice Address - Country:US
Practice Address - Phone:602-755-0800
Practice Address - Fax:602-560-2721
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10908363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50006878Medicaid
CO50006878Medicaid
COC811414Medicare PIN