MEDICARE: DR. SHANE M SUMMERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	UNKNOWN	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225189350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANE M SUMMERS M.D.

Provider Business Mailing Address
First Line	:	5321 N 48TH ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98407-3821
Country	:	US
Telephone Number	:	210-887-6156
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-6200
Country	:	US
Telephone Number	:	253-968-2252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	10/24/2023

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