Provider Demographics
NPI:1720366768
Name:SPEARS, JIMMY (PA-C)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:
Last Name:SPEARS
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 41638
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1638
Mailing Address - Country:US
Mailing Address - Phone:844-900-2567
Mailing Address - Fax:
Practice Address - Street 1:10825 W MCDOWELL RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-8539
Practice Address - Country:US
Practice Address - Phone:844-900-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00199363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical