Healthcare Provider Details

I. General information

NPI: 1598875452
Provider Name (Legal Business Name): JOHN CARL SUMMER BREITNER M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 VILLAGGIO S
PALM SPRINGS CA
92262-6397
US

IV. Provider business mailing address

454 VILLAGGIO S
PALM SPRINGS CA
92262-6397
US

V. Phone/Fax

Practice location:
  • Phone: 514-441-1776
  • Fax: 514-221-4700
Mailing address:
  • Phone: 514-441-1776
  • Fax: 514-221-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number44404
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number44404
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberC134038
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberC134038
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number33388
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number33388
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: