Provider Demographics
NPI:1144985128
Name:SPEAR, NICHOLAS RAY (PA-C)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:RAY
Last Name:SPEAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:PALOMAR MOUNTAIN
Mailing Address - State:CA
Mailing Address - Zip Code:92060-0176
Mailing Address - Country:US
Mailing Address - Phone:619-699-9839
Mailing Address - Fax:
Practice Address - Street 1:16603 JOHN HENRY LN
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-6931
Practice Address - Country:US
Practice Address - Phone:619-699-9839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant