Healthcare Provider Details

I. General information

NPI: 1154364560
Provider Name (Legal Business Name): ARTHUR TIMOTHY SUMRALL II M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8383 N DAVIS HWY
PENSACOLA FL
32514-6039
US

IV. Provider business mailing address

DEPT AT 952627
ATLANTA GA
31192-2627
US

V. Phone/Fax

Practice location:
  • Phone: 850-494-4000
  • Fax:
Mailing address:
  • Phone: 850-476-8602
  • Fax: 850-474-3518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME94665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: