Healthcare Provider Details

I. General information

NPI: 1376568709
Provider Name (Legal Business Name): ROBERT SUMMITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 WOLF TRAIL CV
GERMANTOWN TN
38138-1753
US

IV. Provider business mailing address

8110 N BROTHER BLVD STE 200
BARTLETT TN
38133-2760
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-9222
  • Fax:
Mailing address:
  • Phone: 901-255-5221
  • Fax: 901-373-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number15838
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: