Provider Demographics
NPI:1528069986
Name:SPECK, DAVID DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEAN
Last Name:SPECK
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 1:35 ARTERIAL W
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2785
Mailing Address - Country:US
Mailing Address - Phone:315-253-8495
Mailing Address - Fax:315-253-8496
Practice Address - Street 1:35 ARTERIAL W
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2785
Practice Address - Country:US
Practice Address - Phone:315-253-8495
Practice Address - Fax:315-253-8496
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142615-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00764109-2Medicaid
NY39066BMedicare ID - Type Unspecified
NY00764109-2Medicaid