Healthcare Provider Details

I. General information

NPI: 1265471650
Provider Name (Legal Business Name): WILLIAM C SUMMERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 05/31/2024
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 WATSON RD STE 202
SAINT LOUIS MO
63109-1251
US

IV. Provider business mailing address

3915 WATSON RD STE 202
SAINT LOUIS MO
63109-1251
US

V. Phone/Fax

Practice location:
  • Phone: 314-244-3818
  • Fax: 888-464-1108
Mailing address:
  • Phone: 314-244-3818
  • Fax: 888-464-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2007010580
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number39419
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007010580
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: