Healthcare Provider Details

I. General information

NPI: 1558688424
Provider Name (Legal Business Name): SCOTT MATTHEW SUMMERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY 116A/SAC
MATHER CA
95655
US

IV. Provider business mailing address

10535 HOSPITAL WAY 116A/SAC
MATHER CA
95655
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA118176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: