Healthcare Provider Details

I. General information

NPI: 1821392481
Provider Name (Legal Business Name): SHAWN B SUMMERS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD STE 102
PHOENIX AZ
85013-4493
US

IV. Provider business mailing address

PO BOX 36680
PHOENIX AZ
85067-6680
US

V. Phone/Fax

Practice location:
  • Phone: 602-234-1991
  • Fax: 602-234-3748
Mailing address:
  • Phone: 602-234-1991
  • Fax: 602-234-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35794
License Number StateAZ

VIII. Authorized Official

Name: SHAWN B SUMMERS
Title or Position: OWNER
Credential: M.D.
Phone: 602-234-1991