MEDICARE: DR. MARY SUE SUMMERS DVM

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	174M00000X	Veterinarian	2267	OK

General Provider Information

NPI Number	:	1811158017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY SUE SUMMERS DVM

Provider Business Mailing Address
First Line	:	1628 S POST RD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6602
Country	:	US
Telephone Number	:	405-732-4599
Fax Number	:	405-732-5078

Provider Business Practice Location Address
First Line	:	1628 S POST RD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6602
Country	:	US
Telephone Number	:	405-732-4599
Fax Number	:	405-732-5078

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	06/19/2008

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