Basic Information
| Provider Information | |||||||||
| NPI: | 1336118686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPEYERER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 1ST ST N | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338814129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632940670 | ||||||||
| FaxNumber: | 8632983200 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 1ST ST N | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338814129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632940670 | ||||||||
| FaxNumber: | 8632983200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 12/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | ME54224 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 062027100 | 05 | FL | MEDICAID | 010045982 | 01 | FL | MEDICARE ID/ RRM PIN | OTHER |