Healthcare Provider Details

I. General information

NPI: 1104556992
Provider Name (Legal Business Name): CHAD SUMMERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 S DOBSON RD
MESA AZ
85202-7941
US

IV. Provider business mailing address

4573 E OLNEY AVE
GILBERT AZ
85234-7661
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-4138
  • Fax: 480-969-0630
Mailing address:
  • Phone: 208-230-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: