MEDICARE: DR. RICHARD WARREN SUMRALL MD

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	207Q00000X	Family Medicine Physician	MD049564L	PA
2	2083A0100X	Aerospace Medicine Physician	MD049564L	PA

General Provider Information

NPI Number	:	1528023595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WARREN SUMRALL MD

Provider Business Mailing Address
First Line	:	2507 KENNEDY CIR
Second Line	:	USAFSAM/FECM
City	:	BROOKS CITY BASE
State	:	TX
Zip	:	78235-5116
Country	:	US
Telephone Number	:	210-536-5196
Fax Number	:	210-536-4443

Provider Business Practice Location Address
First Line	:	2507 KENNEDY CIR
Second Line	:	USAFSAM/FECM
City	:	BROOKS CITY BASE
State	:	TX
Zip	:	78235-5116
Country	:	US
Telephone Number	:	210-536-5196
Fax Number	:	210-536-4443

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	06/24/2008

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