Provider Demographics
NPI:1245325802
Name:SPEER, CARL GRANBERRY (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:GRANBERRY
Last Name:SPEER
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 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:4531 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2770
Practice Address - Country:US
Practice Address - Phone:850-436-4563
Practice Address - Fax:850-436-4570
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47671207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z011OtherHEALTH OPTIONS
AL009509870Medicaid
100007816OtherRAILROAD MEDICARE
4925602OtherCIGNA
4321992OtherAETNA
000285530006OtherUNITED HEALTH CARE
FL042743800Medicaid
AL059123842OtherBCBS OF ALABAMA
FL17651OtherBCBS OF FLORIDA
Z011OtherHEALTH OPTIONS
AL059123842OtherBCBS OF ALABAMA
AL000033641Medicare PIN